COMDTINST M6000.1E Section A. Administrative Procedures

COMDTINST M6000.1E
CHAPTER 3
PHYSICAL STANDARDS AND EXAMINATION
Section A. Administrative Procedures
1.
2.
3.
4.
5.
6.
7.
8.
9.
Applicability of Physical Standards………………………………………………... 1
Prescribing of Physical Standards…………………………………………………..1
Purpose of Physical Standards………………………………………………........... 1
Application of Physical Standards…………………………………………………. 1
Interpretation of Physical Standards……………………………………………….. 2
Definitions of Terms Used in this Chapter………………………………………… 2
Required Physical Examinations and Their Time Limitations…………………….. 3
Waiver of Physical Standards……………………………………………………… 10
Substitution of Physical Examinations…………………………………………….. 12
Section B. Medical Examination (DD-2808) and Medical History (DD-2807-1)
1. Report of Medical Examination DD-2808…………………………………………. 1
2. Report of Medical History DD-2807-1…………………………………………….. 1
3. Findings and Recommendations of Report of Medical Examination (DD-2808)….. 1
4. Correction of Defects Prior to Overseas Transfer or Sea Duty Deployment………..5
5. Objection to Assumption of Fitness for Duty at Separation………………………... 5
6. Separation Not Appropriate by Reason of Physical Disability…………………….. 6
7. Procedures for Physical Defects Found Prior to Separation……………………….. 6
Figure 3-B-1…………………………………………………………………………….. 7
Figure 3-B-2…………………………………………………………………………….. 8
Section C. Medical Examination Techniques and Lab Testing Standards
1.
2.
3.
4.
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6.
7.
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10.
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12.
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14.
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16.
17.
Scope………………………………………………………………………………..1
Speech Impediment………………………………………………………………… 1
Head, Face, Neck, and Scalp (Item 17 of DD-2808)………………………………. 1
Nose, Sinuses, Mouth, and Throat (Item 19, 20 of DD-2808)……………………...2
Ears (General) and Drums (Item 21, 22 of DD-2808)……………………………... 2
Eyes (General), Ophthalmoscopic, and Pupils (Item 23, 24, 25 of DD-2808)…….. 3
Ocular Mobility (Item 26 of DD-2808)……………………………………………. 5
Heart and Vascular System (Item 27 of DD-2808)………………………………... 5
Lungs and Chest (Item 28 of DD-2808)…………………………………….............9
Anus and Rectum (Item 30 of DD-2808)………………………………………….. 11
Abdomen and Viscera (Item 31 of DD-2808).…………………………...................11
Genitourinary System (Item 32 of DD-2808)………………………………............ 11
Extremities (Item 33, 34, 35 of DD-2808)…………………………………………. 12
Spine and Other Musculoskeletal (Item 36 of DD-2808)………………………….. 14
Identifying Body Marks, Scars, and Tattoos (Item 37 of DD-2808)……………..... 15
Neurologic (Item 39 of DD-2808)………………………………………………..... 16
Psychiatric (Item 40 of DD-2808)…………………………………………………. 17
Chapter 3 Contents
COMDTINST M6000.1E
18. Endocrine System………………………………………………………………….. 18
19. Dental (Item 43 of DD-2808)……………………………………………………… 18
20. Laboratory Findings……………………………………………………………….. 19
Figure 3-C-1………………………………………………………………………………25
21. Height, Weight and Body Build………………………………………………….... 26
22. Distant Visual Acuity and Other Eye Tests……………………………………….. 26
23. Audiometer………………………………………………………………………… 33
24. Psychological and Psychomotor…………………………………………………… 33
Figure 3-C-2………………………………………………………………………………34
Figure 3-C-3………………………………………………………………………………37
Figure 3-C-4………………………………………………………………………………38
Section D. Medical Standards for Appointment, Enlistment and Induction in the Armed
Forces
1. Scope……………………………………………………………………………........ 1
2. Medical Standards…………………………………………………………………....1
3. Policy………………………………………………………………………………... 2
4. Responsibilities of Commandant (CG-11)………………………………………..... 2
5. Height………………………………………………………………………………...3
6. Weight……………………………………………………………………………….. 3
7. Head…………………………………………………………………………………. 3
8. Eyes………………………………………………………………………………….. 3
9. Vision………………………………………………………………………………... 7
10. Ears………………………………………………………………………………….. 8
11. Hearing……………………………………………………………………………… 8
12. Nose, Sinuses, Mouth and Larynx………………………………………………….. 9
13. Dental……………………………………………………………………………….. 10
14. Neck…………………………………………………………………………………. 11
15. Lungs, Chest Wall, Pleura, and Mediastinum………………………………………. 11
16. Heart………………………………………………………………………………….13
17. Abdominal Organs and Gastrointestinal System…………………………………..... 16
18. Female Genitalia…………………………………………………………………….. 19
19. Male Genitalia………………………………………………………………………. 20
20. Urinary System……………………………………………………………………… 21
21. Spine and Sacroiliac Joints………………………………………………………….. 22
22. Upper Extremities ……………………..……………………………………………. 23
23. Lower Extremities……………………………………………………………………25
24. Miscellaneous Conditions of the Extremities……………………………………….. 27
25. Vascular System…………………………………………………………………….. 28
26. Skin and Cellular Tissues…………………………………………………………… 29
27. Blood and Blood-Forming Tissues.………………………………………………… 31
28. Systemic……………………………………………………………………………... 31
29. Endocrine and Metabolic……………………………………………………………. 34
30. Neurologic……………………………………………………………………………35
31. Learning, Psychiatric, and Behavioral..………………………………………………37
32. Tumors and Malignancies…………………………………………………………… 40
Chapter 3 Contents
COMDTINST M6000.1E
33. Miscellaneous……………………………………………………………………….. 40
Figure 3-D-1 Evaluation for Risk OF Head Injury Sequelae…………………………... 42
Figure 3-D-2 Classification and Comparative nomenclature of Cervical Smears……... 43
Section E. Physical Standards for Programs Leading to Commission
1.
2.
3.
4.
5.
6.
7.
8.
Appointment as Cadet, USCG Academy………………………………………… 1
Commissioning of Cadets…………………………………………………………... 2
Enrollment as an Officer Candidate…………………………………………………2
Commissioning of Officer Candidates………………………………………………3
Coast Guard Direct Commission Program…………………………………………. 4
Direct Commission in the CG Reserve…………..………………………………… 4
Direct Commission of Licensed Officers of U. S. Merchant Marine………………. 4
Appointment to Warrant Grade…………………………………………………….. 4
Section F. Physical Standards Applicable to All Personnel (Regular and Reserve) For:
Reenlistment; Enlistment of Prior Service USCG Personnel; Retention; Overseas Duty;
and Sea Duty
1.
2.
3.
4.
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7.
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9.
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11.
12.
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14.
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20.
21.
22.
23.
General Instructions………………………………………………………………… 1
Use of List of Disqualifying Conditions and Defects……………………………….1
Head and Neck………………………………………………………………………2
Esophagus, Nose, Pharynx, Larynx, and Trachea………………………………….. 2
Eyes……………………………………………………………………………….... 2
Ears and Hearing…………………………………………………………………… 5
Lungs and Chest Wall……………………………………………………………….5
Heart and Vascular System………………………………………………………….7
Abdomen and Gastrointestinal System……………………………………………...9
Endocrine and Metabolic Conditions (Diseases)……………………………………11
Genitourinary System………………………………………………………………. 12
Extremities………………………………………………………………………….. 14
Spine, Scapulae, Ribs, and Sacroiliac Joints……………………………………….. 17
Skin and Cellular Tissues…………………………………………………………... 18
Neurological Disorders……………………………………………………………... 19
Psychiatric Disorders. (See section 5-B concerning disposition)…………………... 20
Dental………………………………………………………………………………..21
Blood and Blood-Forming Tissue Diseases…………………………………………21
Systemic Diseases, General Defects, and Miscellaneous Conditions……………… 22
Tumors and Malignant Diseases…………………………………………………… 23
Sexually Transmitted Disease……………………………………………………… 23
Human Immunodeficiency Virus (HIV)…………………………………………… 23
Transplant recipient………………………………………………………………… 24
Section G. Physical Standards for Aviation
1.
2.
Classification of Aviation Personnel……………………………………………….. 1
General Instructions for Aviation Examinations…………………………………… 1
Chapter 3 Contents
COMDTINST M6000.1E
3.
4.
5.
6.
7.
8.
9.
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11.
12.
Restrictions Until Physically Qualified…………………………………………….. 4
Standards for Class l………………………………………………………………... 4
Candidates for Flight Training……………………………………………………... 7
Requirements for Class 2 Aircrew…………………………………………………..10
Requirements for Class 2 Medical Personnel………………………………………. 10
Requirements for Class 2 Technical Observers…………………………………….. 11
Requirements for Class 2 Air Traffic Controllers………………………………….. 11
Requirements for Landing Signal Officer (LSO)…………………………………... 11
Refractive Surgery………………………………………………………………….. 12
Contact Lenses……………………………………………………………………… 13
Section H. Physical Examinations and Standards for Diving Duty
1.
2.
Examinations……………………………………………………………………….. 1
Standards…………………………………………………………………………… 2
Chapter 3 Contents
COMDTINST M6000.1E
Section A. Administrative Procedures
1.
2.
3.
4.
5.
6.
7.
8.
9.
Applicability of Physical Standards ...........................................................................................1
Prescribing of Physical Standard ...............................................................................................1
Purpose of Physical Standards ...................................................................................................1
Application of Physical Standards .............................................................................................1
Interpretation of Physical Standards ..........................................................................................2
Definitions of Terms Used in this Chapter ................................................................................2
Required Physical Examinations and Their Time Limitations ..................................................3
Waiver of Physical Standards ..................................................................................................10
Substitution of Physical Examinations ....................................................................................12
Chapter 3. A. Page i
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Chapter 3. A. Page ii
COMDTINST M6000.1E
CHAPTER THREE – PHYSICAL STANDARDS AND EXAMINATION
Section A. Administrative Procedures.
1.
Applicability of Physical Standards.
a.
CG standards. The provisions of this chapter apply to all personnel of the CG
and CG Reserve on active or inactive duty and to commissioned officers of the
U.S. Public Health Service assigned to active duty with the CG.
b.
Armed Forces standards. Members of the other Armed Forces assigned to the
CG for duty are governed by the applicable instructions of their parent Service
for examination standards and for administrative purposes.
2.
Prescribing of Physical Standards. Individuals to be enlisted, appointed, or
commissioned in the CG or CG Reserve must conform to the physical standards
prescribed by the Commandant. Separate standards are prescribed for various
programs within the Service. All CG members are required to be medically ready
for deployment. All Individual Medical Readiness (IMR) requirements, as
delineated in the Coast Guard Periodic Health Assessment (PHA), COMTINST
M6150.3, are required to be met by CG AD and SELRES members (to include
Direct Commission Officers at point of accession). The CG clinic affiliated with the
point of accession is responsible for inputting the IMR data into the applicable
medical information system (MIS) database (i.e. Medical Readiness Reporting
System (MRRS), etc.).
3.
Purpose of Physical Standards. Physical standards are established for uniformity in
procuring and retaining personnel who are physically fit and emotionally adaptable
to military life. These standards are subject to change at the Commandant's direction
when the needs of the CG dictate.
4.
Application of Physical Standards.
a.
Conformance with Physical Standards Mandatory. To determine physical
fitness, the applicant or member shall be physically examined and required to
meet the physical standards prescribed in this chapter for the program or
specialty and grade or rate involved. An examinee who does not meet the
standards shall be disqualified.
b.
Evaluation of Physical Fitness. The applicant's total physical fitness shall be
carefully considered in relation to the character of the duties to that the
individual may be called upon to perform. Physical profiling is not a CG policy.
Members shall be considered fit for unrestricted worldwide duty when declared
physically qualified. The examiner must be aware of the different physical
standards for various programs. Care shall be taken to ensure an examinee is
not disqualified for minor deviations that are clearly of no future significance
with regard to general health, ability to serve, or to cause premature retirement
for physical disability. However, conditions that are likely to cause future
disability or preclude completing a military career of at least twenty years,
Chapter 3. A. Page 1
COMDTINST M6000.1E
whether by natural progression or by recurrences, are also disqualifying. This
policy shall be followed when an authentic history of such a condition is
established, even though clinical signs may not be evident during the physical
examination or periodic health assessment (PHA).
5.
Interpretation of Physical Standards. Examiners are expected to use discretion in
evaluating the degree of severity of any defect or disability. They are not authorized
to disregard defects or disabilities that are disqualifying in accordance with the
standards found in this Chapter.
6.
Definitions of Terms Used in this Chapter.
a.
Officers. The term "officers" includes commissioned officers, warrant officers,
and commissioned officers of the U.S. Public Health Service (USPHS).
b.
Personnel. The term "personnel" includes members of the CG and CG Reserve,
and the USPHS on AD with the CG.
c.
Medical and Dental Examiners. Medical and dental examiners are medical and
dental officers of the uniformed services, contract physicians and dentists, or
civilian physicians or dentists who have been specifically authorized to provide
professional services to the CG. Some USMTFs have qualified enlisted
examiners who also conduct medical examinations and their findings require
countersignature by a Medical Officer.
d.
Flight Surgeons, Aviation Medical Officers and Aeromedical Physician
Assistants. Officers of a uniformed service who have been so designated
because of special training.
e.
Command/Unit. For administrative action required on the Report of Medical
Examination, DD-2808 the command/unit level is the unit performing personnel
accounting services for the individual being physically examined.
f.
Reviewing/Approving Authority. Commander, Personnel Service Center (PSCde) and HSWL SC are responsible for approval of physical examinations as
outlined herein. Clinic Administrators may act as reviewing and/or approving
authority for physical examinations performed in their AOR, including those
performed by contract physicians and USMTF’s as designated by HSWL SC,
except for those that are aviation or dive related. Clinic Administrators may
request physical examination review/approval authority for Clinic Supervisors
assigned to their clinic from HSWL SC. Reviewing authority shall not be
delegated below the HSC level. Upon approval or disapproval of the physical
examination, an entry in the comments block of the Medical Readiness and
Reporting System (MRRS) will be made stating where the physical was
approved or disapproved and the reason for disapproval, if applicable. Clinic
Administrators may review physical examinations performed by contract
physicians and USMTFs within their AOR.
Chapter 3. A. Page 2
COMDTINST M6000.1E
7.
g.
Convening Authority. Convening Authority is an individual authorized to
convene a medical board as outlined in Physical Disability Evaluation System,
COMDTINST M1850.2 (series).
h.
Time Limitation. The time limitation is the period for which the physical
examination remains valid to accomplish its required purpose. The time
limitation period begins as of the day after the physical examination is
conducted.
Required Physical Examinations and Their Time Limitations.
a.
Enlistment. A physical examination is required for original enlistment in the
CG and the CG Reserve. This physical examination will usually be performed
by Military Entrance Processing Stations (MEPS) and is valid for twenty-four
months. Approved MEPS physicals do not require further review.
Recommendations noted on separation physical examinations from other
services must have been resolved with an indication that the individual meets the
standards. A certified copy of that physical examination must be reviewed and
endorsed by the reviewing authority CG Recruiting Command (CGRC). The
reviewing authority must indicate that the applicant meets the physical standards
for enlistment in the USCG.
(1) Recruiters who believe that applicants have been erroneously physically
disqualified by MEPS, may submit the Report of Medical Examination,
DD-2808 and Report of Medical History, DD-2807-1 (original or clean
copies) along with supporting medical documentation to Commander
(CGRC) for review.
(2) Waiver of physical standards for original enlistment may also be submitted
as above, and in accordance with paragraph 3-A-8 of this Chapter.
(3) Separation physical examinations from any Armed Service may be used for
enlistment in the CG, provided the examination has been performed within
the last twelve (12) months. The physical examination must be as complete
as a MEPS exam, include an HIV antibody test date (within the last 24
months) and result, and a Type II dental examination. A Report of Medical
History, DD-2807-1 must also be included with elaboration of positive
medical history in the remarks section (item #25). Forward all documents
for review to Commander (CGRC).
(4) Prior Service enlisted aviation personnel must obtain an aviation physical
examination from a currently qualified Uniformed Services Flight Surgeon
or AMO within the previous 12 months. This physical examination will be
submitted with the rate determination package to Commander (CGRC).
(5) Occasionally, applicants for initial entry into the Coast Guard will need to
be examined at CG MTFs. In these cases, the physical examination will be
performed per section 3-C. The examining Medical Officer may defer item
#46 of the Report of Medical Examination, DD-2808 to the Reviewing
Authority. Otherwise, the physical standards for entry (sections 3-D, 3-E
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COMDTINST M6000.1E
and 3-G as appropriate) must be meticulously applied when completing this
item. The completed Report of Medical Examination, DD-2808 and Report
of Medical History, DD-2807-1 will be forwarded to the reviewing
authority, Commander (CGRC).
b.
Pre-Commissioning/Appointments. A physical examination is required within
12 months prior to original appointment as an officer in the CG or CG Reserve
for personnel in the following categories:
(1) Appointments to Warrant Grade, except that physical examinations for
members of the CG Ready Reserve must be within 24 months prior to the
date of execution of the Acceptance and Oath of Office, CG-9556.
(2) Appointment of a Direct Commission Officer, prior to the date of execution
of the Acceptance and Oath of office.
(3) Appointment of a Licensed Officer of the U. S. Merchant Marine as a
commissioned officer (examination required within 6 months).
(4) Graduates of the CG Academy and Officer Candidates School, prior to the
execution of the Acceptance and Oath of Office.
c.
Separation from Active Duty.
(1) A complete physical examination is required within 12 months for
retirement, involuntary separation, or release from any active duty
(RELAD) of 30 days or longer into the Ready Reserves (selected drilling or
IRR).
(2) Other members separating from the CG e.g., discharge or transfer to
standby reserve (non-drilling) may request a medical and/or dental
examination. The medical examination must include: notation of any
current problems, a blood pressure measurement, and address items on the
preventive medicine stamp. In addition to the above, the practitioner shall
ascertain the health needs of the member and undertake measures deemed
necessary to meet those needs. The dental examination, if requested, must
at least be a Type III exam. These examinations may be annotated on a SF600, and upon completion, do not require approval.
(3) For members enrolled in the Occupational Medical Surveillance and
Evaluation Program (OMSEP), see Chapter 12 of this Manual for guidance.
(4) See Chapter 12 of the CG Personnel Manual, COMDTINST M1000.6
(series), for amplification on administrative discharge procedures.
d.
Overseas Transfer, Sea Duty and Port Security Unit (PSU) Assignment,
Modified Physical Screening.
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COMDTINST M6000.1E
(1) To help identify and resolve health related issues prior to transfer a
modified physical screening utilizing the Modified Screening For: Overseas
Assignment and/or Sea Duty Health Screening, CG-6100 is required for all
personnel if one of the following apply:
(a) PCS transfer to vessel with a deployment schedule of 60 consecutive
days or more (out of 365).
(b) PCS transfer to an overseas assignment. (e.g., Alaska, Hawaii or
Puerto Rico)
(c) Transferring from one overseas assignment to another overseas
assignment.
(d) PSU personnel (Must be done annually).
(2) The Modified Screening For: Overseas Assignment and/or Sea Duty Health
Screening, CG-6100 must be completed as follows: Section B must be
completed and signed by the patient. Section C thru E must be completed
and signed by either a civilian, DOD or CG medical or dental provider, or
CG IDHS. Any responses of medical or dental significance requiring
further clarification or evaluation need to be reviewed by either a civilian,
DOD or CG medical or dental provider. Section F must be completed and
signed by the cognizant clinic administrator for final approval or
disapproval. The Modified Screening For: Overseas Assignment and/or Sea
Duty Health Screening, CG-6100 must be placed in section 1 of the health
record. The modified physical screening will include the following:
(a) A health history completed by the evaluee. (The evaluee will certify by
signature that all responses are true).
(b) Documentation of the previous approved physical examination to
include the status of recommendations and summary of significant
health changes.
(c) Review of the health record to ensure routine health maintenance items
are up-to-date to include:
1. Routine gynecologic examinations.
2. Two pairs of glasses and gas mask inserts for PSU personnel if
required to correct refractive error, DNA sampling, G-6-PD
screening, immunizations, HIV testing and a Type 2 dental
examination.
(d) Review malaria chemoprophylaxis, TST and special health concern
requirements. Contact the Center for Disease Control and Prevention
(CDC) at http://www.cdc.gov or http://www.travel.state.gov for
Chapter 3. A. Page 5
COMDTINST M6000.1E
information. Questions regarding the appropriate preventive medical
measures should be referred to Commandant (CG-1121).
(e) If PCS transferring to a foreign country, HIV antibody test must have
been conducted within the past 6 months with results noted prior to
transfer.
(f) If an evaluee is enrolled (or will be enrolled based on new assignment)
in the Occupational Medical Surveillance and Evaluation Program
(OMSEP), ensure appropriate periodic/basic examination is performed.
e.
Applicant.
(1) Commissioning Programs. A physical examination is required for
applicants for entry into the CG as follows:
(a) CG Academy: DODMERB physical examination within 24 months.
(b) Officer Candidate School: MEPS physical within 24 months of entry
date, except.
1. CG personnel on active duty may obtain the physical examination
at a USMTF within 24 months of entry date.
2. Members of other Armed Services may submit a physical
examination from a USMTF provided the examination has been
performed within the past twelve (12) months and is as complete
as a MEPS physical examination.
(c) Direct commission: MEPS physical within 24 months of entry date or
oath of office for Ready Reserve Direct Commission, except aviation
programs, where examination by a Uniformed Service Flight Surgeon
or AMO is required within 12 months of entry date.
(d) Applicants for service academies, ROTC scholarship programs, and the
Uniformed Services University School of Health Sciences (USUHS)
are authorized to utilize MTFs for their initial physical examination and
additional testing if necessary. (Office of Assistant Secretary of
Defense Health Affairs, OASD (HA) policy memo 9900003/Physical
Examinations for ROTC Applicants (notal)).
1. Applicants for entry into these program and prospective flight
personnel should be treated as mission related priorities with
scheduling precedence associated with priority group 1.
2. Scheduling of physical examinations, additional tests and
evaluations are to be conducted in a timely manner.
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COMDTINST M6000.1E
(2) Aviation. An aviation physical examination is required for applicants for
training in all categories of aviation specialties. This physical examination
is valid for 24 months for Class II applicants and 12 months for pilot
applicants.
(3) Diving. A dive applicant physical examination is required for all applicants
for duty involving diving, and is valid for twelve months.
f.
Pre-Training Screening Examinations. A screening examination is required
within 1 week of reporting to the CG Academy, Officer Candidate School,
Direct Commission Officer orientation, or the Recruit Training Center. This
screening examination shall be sufficiently thorough to ensure that the person is
free from communicable and infectious diseases, and is physically qualified.
The results of this examination shall be recorded on a Chronological Record of
Medical Care, SF-600 and filed in the health record.
g.
Retired Members Recalled to Active Duty. A physical examination is required
for retired personnel who are recalled to active duty. This physical examination
is valid for 12 months. A physical examination performed for retirement may be
used for recall providing the date of recall is within 6 months of the date of the
physical examination.
h.
Annual. An annual physical examination, consisting of the Report of Medical
Examination, DD-2808, and Report of Medical History, DD-2807-1, and
completion of the appropriate health risk assessment is required on all aviation
personnel age 50 or older.
i.
Biennial.
(1) Biennial physical examination is required every 2 years after initial
designation, until age 48, for the following:
(a) All aviation personnel (including air traffic controllers) the initial
physical examination (which will count as the PHA) will consist of the
Report of Medical Examination, DD-2808 and Report of Medical
History, DD-2807-1, and completion of the Navy Fleet and Marine
Corps Health Risk Assessment (HRA). The subsequent annual aviation
physical examination will be the PHA. These two exams will alternate
every other year until age 50.
(b) All Landing Signal Officers (LSO).
(2) The biennial exam will be performed either within 2 months prior to the
members birth month or during the members birth month. The period of
validity of the biennial physical will be aligned with the last day of the
service member’s birth month. (Example: someone born on 3 October
would have August, September, and October in which to accomplish his/her
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COMDTINST M6000.1E
physical. No matter when accomplished in that time frame, the period of
validity of that exam is until 31 October two years later).
(3) The requirement to perform a biennial exam will not be suspended in the
event of training exercises or deployment. Aircrew with scheduled
deployment during their 90 day window to accomplish their biennial exam
may accomplish their biennial exam an additional 90 days prior and
continue with the same valid end date. This may result in a member having
a valid biennial for 30 months. Members unable to accomplish a biennial
exam prior to being deployed will be granted an additional 60 days upon
return in which to accomplish their physical.
(4) Additionally, a comprehensive physical may be required during a postmishap investigation, MEB, or as part of a work-up for a medical
disqualification.
(5) Personnel designated as aircrew are expected to maintain a biennial exam
schedule regardless of current aviation duty status.
j.
Triennial. A physical examination is required every three (3) years for all PHS
officers detailed to the CG who are 50 years of age or older.
k.
Periodic Health Assessment (PHA). The PHA is a multi-component process
that will ensure CG members are ready for deployment, ensure individual
medical readiness (IMR) data is electronically recorded, and deliver evidencebased clinical preventive services. The PHA will address prevention of disease
and injury by focusing on prevention strategies each member can incorporate
into his/her lifestyle. As per Coast Guard Periodic Health Assessment (PHA),
COMDTINST 6150.3 (series) the PHA has replaced the routine five year
(quinquennial) physical examination. Every CG member will receive a PHA
annually during the member’s birth month period. For the purpose of this
Instruction, a member’s birth month period is defined as the actual month of
birth and the preceding two (2) months. Specialty examinations (Department of
Defense Medical Examination Review Board (DODMERB), Military Entrance
Processing Station (MEPS), commissioning, appointment to Chief Warrant
Officer (CWO), enlistment, retirement, confinement, release from AD
(RELAD), aviation, landing signal officer (LSO), dive, and Medical Evaluation
Board (MEB) will still be required.
l.
Quinquennial/Diving. A physical examination is required every five (5) years
for all personnel maintaining a current diving qualification (also note "Other” in
item #15.c. of Report of Medical Examination, DD-2808) and for all PHS
officers under age 50 detailed to the CG (per PHS policy).
m. Occupational Medical Surveillance and Evaluation Program (OMSEP). Those
individuals who are occupationally exposed to hazardous substances, physical
Chapter 3. A. Page 8
COMDTINST M6000.1E
energies, or employed in designated occupations must undergo physical
examinations as required by Chapter 12 of this Manual.
n.
Miscellaneous Physical Examinations.
(1) Retention. This examination is done at the direction of the Commanding
Officer when there is substantial doubt as to a member's physical or mental
fitness for duty.
(2) Pre-confinement Physical Screening. In general, personnel who are
presented for this screening, who do not require acute medical treatment or
hospitalization, are fit for confinement. Cases where a member requires
more than routine follow-up medical care, or has certain psychiatric
conditions, that may make them unfit for confinement, should be discussed
with the chief Medical Officer (or his/her representative) at the confining
facility. Personnel requiring detoxification for alcohol or drug dependency
are not fit for confinement; however, members that have been detoxified or
that may require rehabilitation alone are fit for confinement. This screening
shall be recorded on a Chronological Record of Medical Care, SF-600 and
together with a copy of the last complete and approved Report of Physical
Examination Form, DD-2808 and Report of Medical History Form,
DD-2807-1 shall be submitted to the Reviewing Authority.
(3) Post Confinement Physical Examination. Ensure a separation physical
examination has been completed prior to the member departing the
confining facility. The separation physical shall meet the standards of
section 3-F and must be approved by HSWL SC.
(4) Reservists. A District Commander may require any reservist attached to a
command within that area to undergo a complete physical examination if
reasonable doubt exists as to the reservist's physical or mental fitness for
duty.
(5) Non-Fitness for Duty Determination Physical Examinations. The Senior
Health Services Officer (SHSO) retains the authority and responsibility to
determine capability and capacity to conduct non-fitness for duty physical
examinations for all eligible beneficiaries.
(6) Medical Evaluation Boards (MEB). Medical Evaluation Boards are
convened to evaluate the present state of health and fitness for duty of any
active duty/selected reserve member.
o.
Annual Command Afloat Medical Screening. Officers and enlisted personnel
scheduled to assume command afloat shall undergo a medical screening prior to
assignment. The initial screening may be conducted by a Medical Officer where
applicable, or an HS not in the prospective chain of command of the member
being screened. Thereafter, all Commanding Officers and Officers-in-Charge of
afloat units will have an annual command afloat medical screening. This
Chapter 3. A. Page 9
COMDTINST M6000.1E
screening will also be performed by a Medical Officer where available;
otherwise, the screening may be performed by a Health Services Technician
who IS NOT in the chain of command of the person being screened. The
screening process will include a medical history completed by the member, a
visual acuity check, blood pressure measurement, and a thorough review of
interval history in the member's health record. Results are to be recorded on the
Annual Command Afloat Medical Screening, CG-6000-2. The Annual
Command Afloat Medical Screening, CG-6000-2 and a copy of the last PHA
shall then be forwarded to the local approving authority or HSWL SC for
review. HSWL SC will approve or disapprove the screening using section 3-F
(retention standards) as the guiding directive. If a question arises as to the
fitness of the individual, HSWL SC may request additional information from the
examining unit. If HSWL SC is unable to render a decision as to the fitness for
command, the entire command afloat screening package will be forwarded to
Commandant (CG-112) for final action. The reviewed form shall be returned to
the member's command for filing in the member's health record.
p.
8.
Dental Examinations. Annual Type II dental examinations are required for all
active duty and SELRES members.
Waiver of Physical Standards.
a.
Definition of Waiver. A waiver is an authorization to retain the member when
an individual does not meet the physical standards prescribed for the purpose of
the examination.
(1) Normally, a waiver will be granted when it is reasonably expected that the
individual will remain fit for duty and the waiver is in the best interests of
the CG. A service member will not be granted a waiver for a physical
disability determined to be not fit for duty by a physical evaluation board
approved by the Commandant. In these cases, the provisions for retention
on active duty contained in the Physical Disability Evaluation System,
COMDTINST M1850.2 (series) and the Personnel Manual, COMDTINST
M1000.6 (series) apply.
(2) If a member is under consideration by the physical disability evaluation
system, no medical waiver request shall be submitted for physical defects or
conditions described in the medical board. All waiver requests received for
conditions described in the medical board will be returned to the member's
unit without action.
(3) A waiver of a physical standard is not required in a case where a Service
Member's ability to perform on duty has been reviewed through the physical
disability evaluation system and the approved finding of the Commandant is
fit for duty.
b.
Authority for Waivers. Commander PSC-epm (enlisted), PSC-opm (officers),
and PSC-rpm (reserve) have the sole authority to grant waivers. The decision to
Chapter 3. A. Page 10
COMDTINST M6000.1E
authorize a waiver is based on many factors, including the recommendations of
the Chief, Office of Health Services, Commandant (CG-112); the best interest of
the Service; and the individual's training, experience, and duty performance.
Waivers are not normally authorized but shall be reviewed by Commander
(PSC) for the following:
(1) Original enlistment in the regular CG of personnel without prior military
service.
(2) Appointment as a Cadet at the CG Academy.
(3) Training in any aviation or diving category specialty.
(4) A waiver can be terminated if there is appropriate medical justification.
c.
Types of Waivers.
(1) Temporary. A temporary waiver may be authorized when a physical defect
or condition is not stabilized and may either progressively increase or
decrease in severity. These waivers are authorized for a specific period of
time and require medical reevaluation prior to being extended.
(2) Permanent. A permanent waiver may be authorized when a defect or
condition is not normally subject to change or progressive deterioration, and
it has been clearly demonstrated that the condition does not impair the
individual's ability to perform general duty, or the requirements of a
particular specialty, grade, or rate.
d.
Procedures for Recommending Waivers.
(1) Medical Officer. A Medical Officer who considers a defect disqualifying
by the standards, but not a disability for the purpose for which the physical
examination is required, shall:
(a) Enter a detailed description of the defect in Item 77 of the Report of
Medical Examination, DD-2808.
(b) Indicate that either a temporary or permanent waiver is recommended.
(2) Command/Unit Level. When the command receives a Report of Medical
Examination, DD-2808 indicating that an individual is not physically
qualified, the command shall inform the individual that he/she is not
physically qualified. The individual shall inform the command via letter of
his/her intentions to pursue a waiver. The Medical Officer is required to
give a recommendation on whether the waiver is appropriate and if the
individual may perform his/her duties with this physical defect. This
recommendation shall be completed on a Medical Record, SF-507. A cover
letter stating the command's opinion as to the appropriateness of a waiver,
Chapter 3. A. Page 11
COMDTINST M6000.1E
the individual's previous performance of duty, special skills, and any other
pertinent information, shall accompany the Medical Officers report. The
waiver request package shall be forwarded directly from the member's unit
to Commander PSC-epm or opm, or Commandant (PSC-rpm) as
appropriate.
e.
9.
Command Action on Receipt of a Waiver Authorization. A command receiving
authorization from the Commander PSC-epm/opm/rpm for the waiver of a
physical standard shall carefully review the information provided to determine
any duty limitation imposed and specific instructions for future medical
evaluations. Unless otherwise indicated in the authorization, a waiver applies
only to the specific category or purpose for which the physical examination is
required. A copy of the waiver authorization shall be retained in both the
service and health records for the period for which the waiver is authorized.
Copies of future Report of Medical Examination, DD-2808 for the same purpose
shall be endorsed to indicate a waiver is or was in effect.
Substitution of Physical Examinations.
a.
Rule for Substitution of Physical Examinations. In certain circumstances a
physical examination performed for one purpose or category may be substituted
to meet another requirement provided the following criteria are met:
(1) The examinee was physically qualified for the purpose of the previous
examination and all the required tests and recommendations have been
completed.
(2) The Report of Medical Examination, DD-2808 used for substitution bears
an endorsement from the Reviewing Authority or Commandant (CG-112),
as appropriate, indicating that the examinee was qualified for the purpose of
the previous examination.
(3) There has been no significant change in the examinee's medical status since
the previous examination.
(4) A review of the report of the previous examination indicates that the
examinee meets the physical standards of the present requirement.
(5) The date of the previous examination is within the validity period of the
present requirement.
(6) All additional tests and procedures to meet the requirements of the current
physical examination have been completed.
b.
No substitutions are authorized for the following physical examinations:
(1) Enlistment.
Chapter 3. A. Page 12
COMDTINST M6000.1E
(2) Pre-training.
(3) Applicants for or designated personnel in special programs (aviation,
diving, Academy).
(4) Command Afloat.
c.
Procedures for Reporting Substitution. Substitutions of a physical examination
shall be reported by submitting a copy of the Report of Medical Examination,
DD-2808 and Report of Medical History, DD-2807-1 being used to meet the
present requirements with the endorsement illustrated on the Modified
Screening For: Overseas Assignment and/or Sea Duty Health Screening, CG6100. Retain a copy of the substitution endorsement in the health record.
Chapter 3. A. Page 13
COMDTINST M6000.1E
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Chapter 3. A. Page 14
COMDTINST M6000.1E
Section B. Report of Medical Examination Form, DD-2808 and Report of Medical
History Form, DD-2807-1
1.
2.
3.
4.
5.
6.
7.
Report of Medical Examination Form, DD-2808.................................................... 1
Report of Medical History Form, DD-2807-1..........................................................1
Findings and Recommendations of Report of Medical Examination, DD-2808..... 1
Correction of Defects Prior to Overseas Transfer or Sea Duty Deployment........... 5
Objection to Assumption of Fitness for Duty at Separation.................................... 5
Separation Not Appropriate by Reason of Physical Disability................................ 6
Procedures for Physical Defects Found Prior to Separation.................................... 6
Figure 3-B-1............................................................................................................. 7
Figure 3-B-2............................................................................................................. 8
Chapter 3. B. Page i
COMDTINST M6000.1E
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Chapter 3. B. Page ii
COMDTINST M6000.1E
B. Report of Medical Examination, DD-2808 / Report of Medical History, DD-2807-1.
1.
2.
3.
Report of Medical Examination, DD-2808.
a.
Report of Medical Examination, DD-2808. The Report of Medical
Examination, DD-2808 is the proper form for reporting a complete physical
examination. The Report of Medical Examination, DD-2808 can be
obtained from the Commandant (CG-1121) Publications and Directives web
site at http://www.uscg.mil/hq/cg1/cg112/pubs.asp or by
http://www.dior.whs.mil/forms/DD2808.PDF directly from the DOD forms
web site.
b.
Detailed instructions for the preparation and distribution of this form are
contained in section 4-B of this Manual.
Report of Medical History, DD-2807-1.
a.
Report of Medical History, DD-2807-1. The Report of Medical History,
DD-2807-1 is the proper form for reporting a member's medical history.
The Report of Medical History, DD-2807-1 can be obtained from the
Commandant (CG-1121) Publications and Directives web site at
http://www.uscg.mil/hq/cg1/cg112/pubs.asp or by
http://www.dior.whs.mil/forms/DD2807-1.PDF directly from the DOD
forms web site.
b.
Detailed instructions. on the preparation and distribution of this form are
contained in section 4-B of this Manual.
Findings and Recommendations of Report of Medical Examination, DD-2808.
a.
Action by the Medical Examiner.
(1) Review of Findings and Evaluation of Defects. When the results of all
tests have been received and evaluated, and all findings recorded, the
examiner shall consult the appropriate standards of this chapter to
determine if any of the defects noted are disqualifying for the purpose
of the physical examination. When physical defects are found that are
not listed in the standards as disqualifying, but that in the examiner's
opinion would preclude the individual from performing military service
or the duties of the program for which the physical examination was
required, the examiner shall state that opinion on the report indicating
reasons. If in the examiner's opinion, a defect listed as disqualifying is
not disabling for military service, or a particular program, the examiner
shall indicate the basis for this opinion and recommend a waiver in
accordance with the provisions of Section A of this Chapter.
(2) Remediable Defects. When the physical examination of active duty
personnel indicates defects that are remediable or that may become
potentially disabling unless a specific medical program is followed, the
examiner shall clearly state any recommendations. If the examining
facility has the capability of correcting the defect or providing extended
outpatient follow-up or medical care, tentative arrangements for care
Chapter 3. B. Page 1
COMDTINST M6000.1E
shall be scheduled, subject to the approval of the examinee's command.
If the examining facility does not have the capabilities of providing the
necessary care, tentative arrangements for admission or appointment at
another facility shall be scheduled, again subject to the approval of the
individual's command.
(3) Advising the Examinee. After completing the physical examination,
the medical examiner will advise the examinee concerning the findings
of the physical examination. At the same time, the examinee shall be
informed that the examiner is not an approving authority for the
purpose of the examination and that the findings must be approved by
proper authorities.
(4) Disposition of Reports. The original Report of Medical Examination,
DD-2808 and the original Report of Medical History, DD-2807-1,
together with any reports of consultations or special testing reports not
entered on the Report of Medical Examination, DD-2808 or Report of
Medical History, DD-2807-1, shall be forwarded to the activity that
referred the individual for the physical examination.
b.
Review and Action on Reports of Physical Examination by Command.
(1) Command Responsibility.
(a) The command has a major responsibility in ensuring the proper
performance of physical examinations on personnel assigned and
that physical examinations are scheduled sufficiently far in
advance to permit the review of the findings and correction of
medical defects prior to the effective date of the action for which
the examination is required. The command is also responsible to
ensure that the individual complies with the examiner's
recommendations and to initiate any administrative action required
on a Report of Medical Examination.
(b) All Report of Medical Examination, DD-2808's shall be reviewed
by Commanding Officers, or their designee, to determine that the
prescribed forms were used and that all necessary entries were
made.
(c) When the medical examiner recommends further tests or
evaluation, or a program of medical treatment (such as hearing
conservation, periodic blood pressure readings, etc.), the command
will ensure that these tests or examinations are completed or that
the individual is directed to and does comply with the
recommended program. When a necessary test, evaluation, or
program can be completed within a 60 day period, the unit may
hold the Report of Medical Examination, DD-2808 to permit the
forwarding of results. In all cases the command shall endorse the
Report of Medical Examination, DD-2808 to indicate what action
Chapter 3. B. Page 2
COMDTINST M6000.1E
has been taken and forward the report to the reviewing authority if
the 60 day period cannot be met or has elapsed.
(d) Disposition of Reports.
1. If a physical examination is accomplished for a purpose for
which the command has administrative action, the original
Report of Medical Examination, DD-2808 and Report of
Medical History, DD-2807-1 and a return self-addressed
envelope shall be forwarded to the reviewing authority. No
action will be taken to accomplish the purpose for which the
physical examination was taken until the endorsed original of
the report is returned by the reviewing authority indicating
the examinee meets the physical standards for the purpose of
the examination.
2. Approved MEPS physicals do not require further review.
The original physical (Report of Medical Examination, DD2808 and Report of Medical History, DD-2807-1) will be
carried to the Training Center by the individual.
3. If the physical examination is for a purpose requiring the
consent or approval of either Commandant or HSWL SC, the
procedures previously described for command review and
action will be accomplished, except rather than forwarding
the report of the examination directly to the reviewing
authority, it will be included with other supporting documents
(letters, recommendations, etc.) and forwarded through the
chain of command.
4. Units not using a CG health care facility shall send physical
examinations to the appropriate CG clinic (as designated by
HSWL SC or PSC (opm or epm) as appropriate.
c.
Action by the Reviewing Authority.
(1) The Commandant is the final reviewing authority for all physical
examinations, except for applicants to the CG Academy.
(2) Reviewing authorities are listed in Figure 3-B-2.
(3) Flight physicals performed on aviators and aviation school students
during training. Aviation physical exams that are reviewed and
approved by the Navy Operational Medicine Institute (NOMI) or other
armed services Flight Surgeons are considered valid. HSWL SC will
not be the approving authority for these physicals. PSC will remain the
waiver approval authority for these physicals, when a waiver is
required prior to final approval. Upon completion of flight training
and/or assignment to a CG unit, the approved physical will be
considered valid until the last day of the member’s next birth month.
Chapter 3. B. Page 3
COMDTINST M6000.1E
The unit Flight Surgeon will clear the aviator for all flight related duties
based on the approved flight physical.
(4) Commander, Personnel Service Center (PSC-cm) is the reviewing
authority for aviator candidate, aircrew candidate, and diving candidate
physical examinations. Commander, CGRC shall review disapproved
MEPS physicals to ensure proper application of physical standards.
(5) The Department of Defense Medical Examination Review Board
(DODMERB) is the reviewing authority for physical examinations
performed on Academy applicants. MEPS is the reviewing authority
for physical examinations performed in their facilities.
(6) Each Report of Medical Examination, DD-2808 shall be carefully
reviewed to determine whether the findings reported indicate the
examinee does or does not meet the appropriate physical standards. If
further medical evaluation is required to determine that the examinee
does meet the standards, or to resolve doubtful findings, the reviewing
authority shall direct the Commanding Officer or recruiting station to
obtain the evaluation and shall provide such assistance as may be
required.
(7) The reviewing authority shall endorse the original of the Report of
Medical Examination, DD-2808 indicating whether the examinee does
or does not meet the physical standards required. This endorsement, if
at all possible, should be placed in Item 44 of the Report of Medical
Examination, DD-2808 (if there is no room, place endorsement in Item
73). See Figure 3-B-1 for an example of the endorsement. The date of
the endorsement should be no more than 60 days from the start of the
physical. If more than 60 days have elapsed, indicate why on the
endorsement or disapprove the physical.
(8) The endorsed original of the physical examination shall be forwarded
to the individual's unit for filing in the member's health record.
(9) Enter all approved physicals into the Medical Readiness Reporting
System (MRRS). The date entered is the date the member received
their physical (dated entered on the Report of Medical Examination,
DD-2808). Do not enter an unapproved physical into MRRS.
d.
Disposition of Reports.
(1) When the individual meets the appropriate physical standards, forward
the physical examination as indicated in Figure 3-B-2.
(2) When the individual does not meet the appropriate physical standards
and a waiver has been recommended, endorse the physical examination
and forward it in accordance with section 3-A-8.
(3) When the individual is not physically qualified for the purpose of the
examination and a waiver is not recommended, the reviewing authority
will arrange for the examinee to be evaluated by a medical board and
Chapter 3. B. Page 4
COMDTINST M6000.1E
provide administrative action as outlined in the Physical Disability
Evaluation System, COMDTINST M1850.2 (series).
4.
Correction of Defects Prior to Overseas Transfer or Sea Duty Deployment.
a.
Medical Defects. Before an individual departs for an overseas assignment
for 60 consecutive days or greater , to permanent assignment aboard a Polar
Icebreaker, or to a vessel deploying from its home port for 60 consecutive
days or greater, all remediable medical defects, such as hernias, pilonidal
cysts or sinuses requiring surgery, etc., must be corrected. Those defects
that are not easily corrected will be referred to Commander PSC for
consideration. These procedures also apply to personnel presently assigned
to such vessels. In these cases all necessary corrective measures or waivers
will be accomplished prior to the sailing date.
b.
Dental Defects. All essential dental treatment shall be completed prior to
overseas transfer or sea duty deployment except those described in 4-C-3.c
(3) (b). Essential dental treatment constitutes those procedures necessary to
prevent disease and disabilities of the jaw, teeth, and related structures.
This includes extractions, simple and compound restorations, and treatment
for acute oral pathological conditions such as Vincent's stomatitis, acute
gingivitis, and similar conditions that could endanger the health of the
individual during a tour of duty. Missing teeth are to be replaced when
occluding tooth surfaces are so depleted that the individual cannot properly
masticate food. Elective dental procedures (those that may be deferred for
up to twelve months without jeopardizing the patient's health, i.e., Class II
patient need not be completed prior to overseas transfer providing both of
the following conditions exist:
(1) Completion of such elective procedures prior to transfer would delay
the planned transfer.
(2) Adequate Service dental facilities are available at the overseas base.
c.
5.
Vision Defects. A refraction shall be performed on all personnel whose
visual acuity is less than 20/20 in either eye (near or distant) or whose
present eyewear prescription does not correct their vision to 20/20. All
personnel requiring glasses for correction shall have a minimum of two pair
prior to overseas transfer or sea duty deployment. All personnel requiring
corrective lenses shall wear them for the performance of duty.
Objection to Assumption of Fitness for Duty at Separation.
a.
Member’s responsibilities. Any member undergoing separation from the
service that disagrees with the assumption of fitness for duty and claims to
have a physical disability as defined in section 2-A-38 of the Physical
Disability Evaluation System, COMDTINST M1850.2 (series), shall submit
written objections within 10 days of signing the Chronological Record of
Service, CG-4057 to Commander PSC. Such objections based solely on
Chapter 3. B. Page 5
COMDTINST M6000.1E
items of medical history or physical findings will be resolved at the local
level. The member is responsible for submitting copies of the following
information along with the written objections:
(1) Report of Medical Examination, DD-2808.
(2) Report of Medical History, DD-2807-1.
(3) Signed copy of the Chronological Record of Service, CG-4057.
(4) Appropriate consultations and reports.
(5) "Other pertinent documentation."
(6) The rebuttal is a member's responsibility and command endorsement is
not required.
b.
Rebuttal package. The package shall contain thorough documentation of
the physical examination findings, particularly in those areas relating to the
individual's objections. Consultations shall be obtained to thoroughly
evaluate all problems or objections the examinee indicates. Consultations
obtained at the examinee's own expense from a civilian source shall also be
included with the report.
c.
Commander (PSC) responsibility. Commander (PSC) will evaluate each
case and based upon the information submitted take one of the following
actions:
(1) Find separation appropriate, in which case the individual will be so
notified and the normal separation process completed.
(2) Find separation inappropriate, in which case the entire record will be
returned and appropriate action recommended.
(3) Request additional documentation before making a determination.
6.
Separation Not Appropriate by Reason of Physical Disability. When a member
has an impairment (in accordance with section 3-F of this Manual) an Initial
Medical Board shall be convened only if the conditions listed in paragraph 2-C2.(b), Physical Disability Evaluation System, COMDTINST M1850.2 (series),
are also met. Otherwise the member is suitable for separation.
7.
Procedures for Physical Defects Found Prior to Separation.
a.
Policy. No person shall be separated from the Service with any disease in a
communicable state until either rendered noninfectious, or until suitable
provisions have been made for necessary treatment after separation.
b.
Remediable Non-Disqualifying Defects. Remediable physical defects that
would not normally prevent the individual from performing the duties of
grade or rate shall be corrected only if there is reasonable assurance of
complete recovery and sufficient time remaining prior to separation.
Chapter 3. B. Page 6
FIGURE 3-B-1
DATE:
REVIEWERS UNIT
COMDTINST M6000.1E
__________________
Does /does not meet the physical standards for (title or category or purpose of
examination), as prescribed in (appropriate section of Medical Manual, COMDTINST
M6000.1 (series)).
Disqualifying Defects:
Signature and Title of Reviewer
Chapter 3. B. Page 7
COMDTINST M6000.1E
Physical Exam
Purpose
Aviator Candidate
Aircrew Candidate
Diving Candidate
Physician Assistant
Candidate
Flight Surgeon (FS)
FS Candidate
Aviator
Aircrew
Diving
Annual
LSO
Quinquennial
Overseas/Sea Duty
Retention
Retirement
Involuntary
Separation
RELAD
Precom /Appts
Direct Commission
OCS
Enlistment
FIGURE 3-B-2
Note:
Approving
Authority
Reviewing
Authority:
(1,2)
(1,2)
(1,7)
(1,5)
PSC-opm
PSC-epm
NDSTC
PSC-opm
PSC-cm
PSC-cm
HSWL SC
PSC-cm
(1)
(1)
(1)
(1)
(1,4)
(1,4)
PSC-PSD-med
PSC-PSD-med
PSC-PSD-med
PSC-PSD-med
Designated DMO
HSWL SC or
Clinic Administrator
(CA)
HSWL SC or CA
HSWL SC or CA
HSWL SC or CA
HSWL SC or CA
HSWL SC or CA
HSWL SC or CA
(1,4)
(1)
(1,5)
(1,5)
HSWL SC or CA
HSWL SC or CA
CGRC
CGRC
HSWL SC or CA
HSWL SC or CA
CGRC
CGRC
(2)
CGRC
CGRC
(1)(3)
(1)
(1)
(1)(6)
(1)
PSC-PSD-med
PSC-PSD-med
PSC-PSD-med
PSC-PSD-med
Designated DMO
HSWL SC or Clinic
Administrator (CA)
HSWL SC or CA
HSWL SC or CA
HSWL SC or CA
HSWL SC or CA
HSWL SC or CA
HSWL SC or CA
NOTES:
(1) The reviewing authority shall review, endorse and return the original to the member's
unit for filing in the member's or applicant's health record.
(2) Forward the unendorsed physical to the appropriate office (as listed above) with the
application/training request package. That office will forward the physical to CG
PSC for review.
(3) Forward the original and one copy to Commandant (CG-1121) for review.
(4) Ensure that a completed Chronological Record of Care, CG-4057 accompanies the
completed Report of Medical Examination, DD-2808 and Report of Medical History,
DD-2807-1.
(5) Reviewing authority for current USCG or USCGR members only. For all others,
Note (2) above applies. Forward a copy of the first/front page of the Report of
Medical Examination, DD-2808 with endorsement to the appropriate office with the
application package.
Chapter 3. B. Page 8
FIGURE 3-B-2 (cont.)
COMDTINST M6000.1E
(6) Diving Medical Officer (DMO) will be designated by Commandant (CG-1121). The
currently designated DMO is listed on the Operational Medicine website.
(7) Diving candidate physicals shall be forwarded by HSWL SC to Coast Guard Liaison
Office (CGLO) at COMMANDING OFFICER, NAVAL DIVING SALVAGE
TRAINING CENTER, 350 CRAG RD, PANAMA CITY FL 32407-7016.
CGLO will notify member of status of physical exam. Physical exam will be retained at
NDSTC until member commences training at which time the physical exam will be
entered into the health record.
Chapter 3. B. Page 9
COMDTINST M6000.1E
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Chapter 3. B. Page 10
COMDTINST M6000.1E
Section C. Medical Examination Techniques and Lab Testing Standards
1. Scope ....................................................................................................................................1
2. Speech Impediment ..............................................................................................................1
3. Head, Face, Neck, and Scalp (Item 17 of DD-2808) ...........................................................1
4. Nose, Sinuses, Mouth, and Throat (Item 19, 20 of DD-2808).............................................2
5. Ears (General) and Drums (Item 21, 22 of DD-2808) .........................................................2
6. Eyes (General), Ophthalmoscopic, and Pupils (Item 23, 24, 25 of DD-2808) ....................3
7. Ocular Mobility (Item 26 of DD-2808) ...............................................................................5
8. Heart and Vascular System (Item 27 of DD-2808) .............................................................5
9. Lungs and Chest (Item 28 of DD-2808) ..............................................................................9
10. Anus and Rectum (Item 30 of DD-2808) ..........................................................................11
11. Abdomen and Viscera (Item 31 of DD-2808) ...................................................................11
12. Genitourinary System (Item 32 of DD-2808) ....................................................................11
13. Extremities (Item 33, 34, 35 of DD-2808) .........................................................................12
14. Spine and Other Musculoskeletal (Item 36 of DD-2808) ..................................................14
15. Identifying Body Marks, Scars, and Tattoos (Item 37 of DD-2808) .................................15
16. Neurologic (Item 39 of DD-2808) .....................................................................................16
17. Psychiatric (Item 40 of DD-2808) .....................................................................................17
18. Endocrine System ..............................................................................................................18
19. Dental (Item 43 of DD-2808) ............................................................................................18
20. Laboratory Findings ...........................................................................................................19
Figure 3-C-1 ...............................................................................................................................25
21. Height, Weight and Body Build.........................................................................................26
22. Distant Visual Acuity and Other Eye Tests .......................................................................26
23. Audiometer ........................................................................................................................33
24. Psychological and Psychomotor ........................................................................................33
Figure 3-C-2 ...............................................................................................................................34
Figure 3-C-3 ...............................................................................................................................37
Figure 3-C-4 ...............................................................................................................................38
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C. Medical Examination Techniques and Lab Testing Standards.
1.
Scope. This section is a medical examination technique guide applicable for all
physical examinations and periodic health assessments (PHA). Detailed
instructions for the PHA are contained in the CG PHA, COMDTINST 6150.3.
2.
Speech Impediment. Administer the "Reading Aloud Test" (RAT) as listed.
3.
a.
Procedure. Have the examinee stand erect, face you across the room and
read aloud, as if confronting a class of students.
b.
Pauses. If the individual pauses, even momentarily, on any phrase or word,
immediately and sharply say, "What's that?", and require the examinee to
start over again with the first sentence of the test.
c.
Second trial. The person who truly stammers usually will halt again at the
same word phonetic combination often revealing serious stammering.
Examinees who fail to read the test without stammering after three attempts
will be disqualified.
d.
Reading aloud test. “You wished to know all about my grandfather. Well,
he is nearly 93 years old; he dresses himself in an ancient black frock coat
usually minus several buttons; yet he still thinks as swiftly as ever. A long,
flowing beard clings to his chin, giving those who observe him a
pronounced feeling of the utmost respect. When he speaks, his voice is just
a bit cracked and quivers a trifle. Twice each day he plays skillfully and
with zest upon our small organ. Except in the winter when the ooze or
snow or ice is present, he slowly takes a short walk in the open air each day.
We have often urged him to walk more and smoke less, but he always
answers, 'Banana Oil.' Grandfather likes to be modern in his language."
Head, Face, Neck, and Scalp (Item 17 of DD-2808).
a.
Head and Face. Carefully inspect and palpate the head and face for
evidence of injury, deformity, or tumor growth. Record all swollen glands,
deformities, or imperfections noted. Inquire into the cause of all scars and
deformities. If a defect is detected such as moderate or severe acne, cysts,
or scarring, make a statement as to whether this defect will interfere with
wearing military clothing and equipment.
b.
Neck. Carefully inspect and palpate for glandular enlargement, deformity,
crepitus, limitations of motion, and asymmetry; palpate the parotid and
submaxillary regions, the larynx for mobility and position, the thyroid for
size and nodules, and the supraclavicular areas for fullness and masses. If
enlarged lymph nodes are detected describe them in detail with a clinical
opinion of their etiology.
c.
Scalp. Examine for deformities such as depressions and exostosis.
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4.
5.
Nose, Sinuses, Mouth, and Throat (Item 19, 20 of DD-2808).
a.
Nasal or sinus complaints. If there are no nasal or sinus complaints, simple
anterior rhinoscopy will suffice, provided that in this examination, the nasal
mucous membrane, the septum, and the turbinates appear normal. If the
examinee has complaints, a more detailed examination is required. Most
commonly, these complaints are external nasal deformity, nasal obstruction,
partial or complete on one or both sides; nasal discharge; postnasal
discharge; sneezing; nasal bleeding; facial pain; and headaches.
b.
Abnormalities in the mucous membrane. Abnormalities in the mucous
membrane in the region of the sinus ostia, the presence of pus in specific
areas, and the cytologic study of the secretions may provide valuable
information regarding the type and location of the sinus infection. Evaluate
tenderness over the sinuses by transillumination or x-ray. Examination for
sinus tenderness should include pressure applied over the anterior walls of
the frontal sinuses and the floors of these cavities and also pressure over the
cheeks. Determine if there is any tenderness to percussion beyond the
boundaries (as determined by x-ray) of the frontal sinuses. Note any sensory
changes in the distribution of the supra-orbital or infra-orbital nerves that
may indicate the presence of neoplasm. Note any external swelling of the
forehead, orbit, cheek, and alveolar ridge.
c.
Mouth and tongue. Many systemic diseases manifest themselves as lesions
of the mouth and tongue; namely leukemia, syphilis, agranulocytosis,
pemphigus, erythema multiform, and dermatitis medicamentosa. Note any
abnormalities or lesions on lips or buccal mucous membrane, gums, tongue,
palate, floor of mouth, and ostia of the salivary ducts. Note the condition of
the teeth. Pay particular attention to any abnormal position, size, or the
presence of tremors or paralysis of the tongue and the movement of the soft
palate on phonation.
d.
Throat. Record any abnormal findings of the throat. If tonsils are
enucleated, note possible presence and position of residual or recurrent
lymphoid tissue and the degree of scarring. If tonsils are present, note size,
presence of pus in crypts, and any associated cervical lymphadenopathy.
Note presence of exudate, ulceration, or evidence of neoplasm on the
posterior pharyngeal crypts. Describe any hypertrophied lymphoid tissue
on the posterior pharyngeal wall or in the lateral angle of the pharynx and
note if there is evidence of swelling that displaces the tonsils, indicating
possible neoplasm or abscess. Perform direct or indirect laryngoscopy if
the individual complains of hoarseness.
Ears (General) and Drums (Item 21, 22 of DD-2808). Inspect the auricle, the
external canal, and the tympanic membrane using a speculum and good light.
Abnormalities (congenital or acquired) in size, shape, or form of the auricles,
canals, or tympanic membranes must be noted, evaluated, and recorded.
a.
Auricle. Note deformities, lacerations, ulcerations, and skin disease.
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b.
External canal. Note any abnormality of the size or shape of the canal and
inspect the skin to detect evidence of disease. If there is material in the
canal, note whether it is normal cerumen, foreign body, or exudate.
Determine the source of any exudate in the canal. If this exudate has its
origins in the middle ear, record whether it is serous, purulent, sanguinous,
or mucoid; whether it is foul smelling; and, whether it is profuse or scanty.
c.
Tympanic membrane. Remove all exudate and debris from the canal and
tympanic membrane before examination. Unless the canal is of abnormal
shape, visualize the entire tympanic membrane and note and record the
following points.
(1) List any abnormality of the landmarks indicating scarring, retraction,
bulging, or inflammation.
(2) Note whether the tympanum is air containing.
(3) List any perforations, giving size and position, indicating whether they
are marginal or central, which quadrant is involved, and whether it is
the flaccid or the tense portion of the membrane that is included.
(4) Attempt, if the tympanic membrane is perforated, to determine the state
of the middle ear contents, particularly concerning hyperplastic
tympanic mucosa, granulation tissue, cholesteatoma, and bone necrosis.
Do the pathological changes indicate an acute or chronic process? This
clinical objective examination should permit evaluating the infectious
process in the middle ear and making a reasonably accurate statement
regarding the chronicity of the infection; the extent and type of
involvement of the mastoid; the prognosis regarding hearing; and, the
type of treatment (medical or surgical) that is required.
(5) Note, for all aviation and dive physical examinations, whether the
examinee can properly auto insufflate tympanic membrane.
6.
Eyes (General), Ophthalmoscopic, and Pupils (Item 23, 24, 25 of DD-2808).
External and ophthalmoscopic examinations of the eyes are required on all
examinations. Contact lenses shall not be worn during any part of the eye
examination, including visual acuity testing. It is essential that such lenses not
be worn for 72 hours preceding examination. The strength of the contact that an
examinee may possess shall not be accepted as the refraction nor will it be
entered as such in Item 60, Report of Medical Examination Form DD-2808.
The general examination shall include the following specific points and checks:
a.
General.
(1) Bony abnormality or facial asymmetry.
(2) Position of the eyes.
(3) Exophthalmus.
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(4) Manifest deviation of the visual axis.
(5) Epiphora or discharge.
(6) Position of puncta or discharge when pressure exerted over lacrimal
sac.
b.
Lids.
(1) Ptosis.
(2) Position of lashes, eversion or inversion.
(3) Inflammation of margins.
(4) Cysts or tumors.
c.
Conjunctiva. Examine the palpebral and bulbar conjunctiva by:
(1) Eversion of upper lid.
(2) Depression and eversion of lower lid.
(3) Manually separating both lids.
d.
Pupils.
(1) Size.
(2) Shape.
(3) Equality.
(4) Direct, consensual, and accommodative reactions.
e.
Directly and obliquely examine.
(1) Cornea. For clarity, discrete opacities, superficial or deep scarring,
pannus, vascularization, pterygium, and the integrity of the epithelium.
(2) Anterior Chamber. For depth, alteration of normal character of the
aqueous humor, and retained foreign bodies.
(3) Iris. For abnormalities and pathologic changes.
(4) Crystalline Lens. For clouding or opacities.
f.
Ophthalmoscopic.
(1) Media. Examine with a plano ophthalmoscopic lens at a distance of
approximately 18 to 21 inches from the eye. Localize and describe any
opacity appearing in the red reflex or direct examination or on eye
movement.
(2) Fundus. Examine with the strongest plus or weakest minus lens
necessary to bring optic nerve into sharp focus. Pay particular attention
to the color, surface, and margin of the optic nerve, also record any
abnormality of the pigmentation or vasculature of the retina.
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(3) Macula. Examine for any change.
7.
Ocular Motility (Item 26 of DD-2808).
a. Ascertain the motility of the eyeballs by testing for binocular eye movement
(ductions and versions) in the cardinal positions of gaze. If any
abnormalities are suspected, verify with the cover/uncover test.
b. Observe if the eyes move together and whether there is loss of motion in any
direction (paralysis or paresis), or absence of muscle balance, whether latent
(heterophoria) or manifest (strabismus / heterotropia). Have the examinee
look at a test object and alternately cover and uncover one eye leaving the
other uncovered and observe the movement, if any, in each eye. In
heterotropia movement occurs only in the eye that is covered and
uncovered; on being covered, it deviates and on being uncovered, it swings
back into place to take up fixation with the other eye that has remained
uncovered.
8.
Heart and Vascular System (Item 27 of DD-2808).
a.
General. In direct light, have the examinee stand at ease, with arms relaxed
and hanging by sides. Do not permit the examinee to move from side to
side or twist to assist in the examination, as these maneuvers may distort
landmarks: and increase muscular resistance of the chest wall. Examine the
heart by the following methods: inspection, palpation, auscultation, and
when considered necessary, by mensuration.
b.
Inspection. Begin from above and go downward, with special reference to
the following:
(1) Any malformation that might change the normal relations of the heart.
(2) Pulsations in the suprasternal notch and in the second interspaces to the
right and left of the sternum.
(3) Character of the precordial impulse.
(4) Epigastric pulsations.
c.
Palpation. First palpate to detect thrills over the carotids, thyroid glands,
suprasternal notch, apex of the heart, and at the base. Use palms of hands in
palpating and use light pressure, as hard pressure may obliterate a thrill. To
locate the maximum cardiac impulse, have the examinee stoop and throw
the shoulders slightly forward, thus bringing the heart into the closest
possible relation with the chest wall. Palpate both radial arteries at the same
time for equality in rate and volume. Run the finger along the artery to note
any changes in its walls. Place the palm of one hand over the heart and
fingers of the other over the radial artery to see if all ventricular
contractions are transmitted. Palpate to determine the degree of tension or
compression of the pulse. In an estimate of pulse rate, the excitement of
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undergoing a physical examination must be considered.
d.
Auscultation. In auscultating the heart, bear in mind the four points where
the normal heart sounds are heard with maximum intensity:
(1) Aortic area, second interspace to right of sternum. Here the second
sound is distinct.
(2) Tricuspid area, junction of the fifth right rib with the sternum. Here the
first sound is distinct.
(3) Pulmonic area, second interspace to left of sternum. Here the second
sound is most distinct.
(4) Mitral area, fifth interspace to left of sternum. Here the first sound is
most clearly heard.
e.
Blood Pressure.
(1) Only the sitting blood pressure is required.
(2) Other positions required only if sitting blood pressure exceeds 139
mmHG systolic or 89 mmHG diastolic.
(3) Take the sitting blood pressure with the examinee comfortably relaxed
in a sitting position with legs uncrossed and the arm placed on a rest at
the horizontal level of the heart. The condition of the arteries, the
tenseness of the pulse, and the degree of accentuation of the aortic
second sound must be taken into consideration, as well as the relation
between the systolic and diastolic pressure.
(4) Personnel recording blood pressure must be familiar with situations that
result in spurious elevation. A Medical Officer shall repeat the
determination in doubtful or abnormal cases and ensure that the proper
recording technique was used.
(5) Artificially high blood pressure may be observed as follows.
(a) If the compressive cuff is too loosely applied.
(b) If the compressive cuff is too small for the arm size. Cuff width
should be approximately one-half arm circumference. In a very
large or very heavily muscled individual, this may require an
"oversize" cuff.
(c) If the blood pressure is repetitively taken before complete cuff
deflation occurs. Trapping of venous blood in the extremity results
in a progressive increase in recorded blood pressure.
(6) At least five minutes of rest should precede the blood pressure
recording. Due regard must be given to physiologic effects such as
excitement, recent exercise, smoking or caffeine within the preceding
thirty minutes, and illness.
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(7) No examinee shall be rejected based on the results of a single
recording. If 2 out of the 3 positions exceed 139 mmHG systolic or 89
mmHG diastolic, the disqualifying blood pressures will be rechecked
for 3 consecutive days in the morning and afternoon of each day and
averaged. The first determination shall be recorded in Item 58 and the
repeat determinations in Item 73 of DD-2808. Patients being treated
for HTN that have blood pressures less than 140 systolic and 90
diastolic do not require three-day blood pressure checks.
(8) While emphasizing that a diagnosis of elevated blood pressure not be
prematurely made, it seems evident that a single "near normal" level
does not negate the significance of many elevated recordings.
f.
Blood Pressure Determination.
(1) Use procedures recommended by the American Heart Association.
(2) Take the systolic reading as either the palpatory or auscultatory reading
depending on which is higher. In most normal subjects, the
auscultatory reading is slightly higher.
(3) Record diastolic pressure as the level at which the cardiac tones
disappear by auscultation. In a few normal subjects, particularly in thin
individuals and usually because of excessive stethoscope pressure,
cardiac tones may be heard to extremely low levels. In these instances,
if the technique is correct and there is no underlying valvular defect, a
diastolic reading will be taken at the change in tone.
(4) Note variations of blood pressures with the position change if there is a
history of syncope or symptoms to suggest postural hypertension.
(5) Obtain blood pressure in the legs when simultaneous palpation of the
pulses in upper and lower extremities reveals a discrepancy in pulse
volume.
g.
Pulse Rate.
(1) Determine the pulse rate immediately after the blood pressure. Only
the sitting position is required.
(2) In the presence of a relevant history, arrhythmia, or a pulse of less than
50 or over 100, an electrocardiogram will be obtained.
h.
Interpretation of Abnormal Signs and Symptoms. The excitement of the
examination may produce violent and rapid heart action often associated
with a transient systolic murmur. Such conditions may erroneously be
attributed to the effects of exertion; they usually disappear promptly in the
recumbent posture. Try to recognize the excitable individuals and take
measures to eliminate psychic influences from the test.
i.
Hypertrophy-Dilatation. An apex beat located at or beyond the left nipple
line, or below the sixth rib, suggests an enlargement sufficient to disqualify
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for military service. Its cause, either valvular disease or hypertension in the
majority of cases, should be sought. A horizontal position of the heart must
be distinguished from left ventricular enlargement. EKG, ultrasound
studies, fluoroscopy, and chest x-ray may be indicated for diagnosis.
j.
Physiological Murmurs. Cardiac murmurs are the most certain physical
signs by which valvular disease may be recognized and its location
determined. The discovery of any murmur demands diligent search for
other evidence of heart disease. Murmurs may occur, however, in the
absence of valvular lesions or other cardiac disease. Such physiological
murmurs are not causes for rejection.
(1) Characteristics. The following characteristics of physiological
murmurs will help differentiate them from organic murmurs:
(a) They are always systolic in time.
(b) They are usually heard over a small area, the most common place
being over the pulmonic valve and mitral valve.
(c) They change with position of the body, disappearing in certain
positions. They are loudest usually in the recumbent position and
are sometimes heard only in that position.
(d) They are transient in character, frequently disappearing after
exercise.
(e) They are usually short, rarely occupying all of the systole, and are
soft and of blowing quality.
(f) There is no evidence of heart disease or cardiac enlargement.
(2) Most Common Types. The most common types of physiological
murmurs are:
(a) Those heard over the second and third left interspaces during
expiration, disappearing during forced inspiration. These are
particularly common in individuals with flexible chests, who can
produce extreme forced expiration. Under such circumstances,
murmurs may be associated with a vibratory thrust.
(b) Cardio-respiratory murmurs caused by movements of the heart
against air in a part of the lung overlapping the heart. They usually
vary in different phases of respiration and at times disappear
completely when the breath is held.
(c) Prolongations of the apical first sound that are often mistaken for
murmurs.
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(3) Diagnosis. An EKG, chest x-ray, and echocardiogram are usually
indicated to firmly establish the true cause of a murmur and should be
done if there is any question of abnormality.
k.
9.
Electrocardiograms. Use standard positions for precordial leads when
completing electrocardiograms.
Lungs and Chest (Item 28 of DD-2808).
a.
History and x-ray studies. A thorough examination includes a complete
history (DD-2807-1) careful physical examination, and necessary x-ray and
laboratory studies. In screening examinations, the history and x-ray studies
are the most immediately revealing examination techniques.
b.
Exam. Remember that several disqualifying diseases such as tuberculosis
and sarcoidosis may not be detectable by physical examination and the
absence of abnormal physical signs does not rule out disqualifying
pulmonary disease. Such diseases, as well as others (neopasms and fungus
infections), may be detected only by chest x-ray.
(1) Conduct the physical examination in a thorough, systematic fashion.
Take particular care to detect pectus abnormalities, kyphosis, scoliosis,
wheezing, persistent rhonchi, basilar rales, digital clubbing, and
cyanosis. Any of these findings require additional intensive inquiry
into the patient's history if subtle functional abnormalities or mild
asthma, bronchitis, or bronchiectasis are to be suspected and evaluated.
The physical examination shall include the following:
(a) Inspection. The examinee should be seated in a comfortable,
relaxed position with the direct light falling upon the chest.
Careful comparison of the findings elicited over symmetrical areas
on the two sides of the chest gives the most accurate information
regarding condition of the underlying structures. Observe for
asymmetry of the thoracic cage, abnormal pulsation, atrophy of the
shoulder girdle or pectoral muscles, limited or lagging expansion
on forced inspiration. The large, rounded relatively immobile
"barrel" chest suggests pulmonary emphysema.
(b) Palpation.
1. Observe for tumors of the breast or thoracic wall, enlarged
cervical, supraclavicular, or axillary lymph nodes, suprasternal
notch, and thrills associated with respiration or the cardiac
cycle.
2. A breast examination should also be performed based upon the
Clinical Preventive Services guidance as contained in the Coast
Guard Periodic Health Assessment, COMDTINST 6150.3.
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Monthly self-examination is recommended for all adult female
patients.
(c) Auscultation. Instruct the examinee to breathe freely but deeply
through the mouth. Listen to an entire respiratory cycle before
moving the stethoscope bell to another area. Note wheezing, rales,
or friction rubs. Compare the pitch and intensity of breath sounds
heard over symmetrical areas of the two lungs. Instruct the
examinee to exhale during this process. Note any rales, paying
particular attention to moist rales that "break" with the cough or
fine rales heard at the beginning of inspiration immediately after
cough.
(2) Do not hesitate to expand the history if abnormalities are detected
during examination or in repeating the examination if chest film
abnormalities are detected.
c.
Asthma bronchiectasis, and tuberculosis. There are three conditions that are
most often inadequately evaluated and result in unnecessary and avoidable
expense and time loss. These three are asthma (to include "asthmatic
bronchitis"), bronchiectasis, and tuberculosis.
(1) Asthma. In evaluating asthma, a careful history is of prime importance
since this condition is characteristically intermittent and may be absent
at the time of examination. Careful attention to a history of episodic
wheezing with or without accompanying respiratory infection is
essential. Ask about the use of prescription or over-the-counter
bronchodilators.
(2) Bronchiectasis. Individuals who report a history of frequent respiratory
infections accompanied by purulent sputum or multiple episodes of
pneumonia should be suspected of bronchiectasis. This diagnosis can
be further supported by a finding of post-tussive rales at one or both
bases posteriorly or by a finding of lacy densities at the lung base on
the chest film. If bronchiectasis is considered on the basis of history,
medical findings or chest film abnormalities, seek confirmatory opinion
from the examinee's personal physician or refer the examinee to a
pulmonologist for evaluation and recommendations.
(3) Tuberculosis (TB).
(a) Active TB is often asymptomatic and not accompanied by
abnormal physical findings unless the disease is advanced. If only
such manifestations as hemoptysis or draining sinuses are looked
for, most cases of TB will be missed.
(b) The QuantiFERON® - TB Gold test (QFT-G) or theTuberculin
Skin Test (TST) can aid in diagnosing Mycobacterium tuberculosis
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COMDTINST M6000.1E
infection, including latent tuberculosis infection (LTBI) and
tuberculosis (TB) disease.
(c) If positive, evaluate the chest film for any infiltrate, cavity, or
nodular lesion involving the apical or posterior segments of an
upper lobe or superior segment of a lower lobe. Many tuberculosis
lesions may be partially hidden or obscured by the clavicles.
When any suspicion of an apical abnormality exists, an apical
lordotic view must be obtained for clarification.
(d) It is neither practical nor possible, in most instances, to determine
whether or not a TB lesion is inactive on the basis of a single
radiologic examination. Therefore, refer any examinee suspected
of TB to a pulmonologist or to an appropriate public health clinic
for evaluation.
(e) An initial TST is mandatory and shall be made a part of the
physical examination for all personnel entering on active duty for a
period of 30 days or more.
(f) See www.cdc.gov/tb/ for additional information on Tuberculosis
Management.
10. Anus and Rectum (Item 30 of DD-2808). All examinations shall include a
visual inspection of the anus. Perform a digital rectal examination and test for
fecal occult blood in accordance with the Clinical Preventive Service guidelines
as contained in the CG Periodic Health Assessment, COMDTINST 6150.3.
When anorectal disease is suspected a consultation with a gastroenterologist
may be indicated.
11. Abdomen and Viscera (Item 31 of DD-2808).
a.
Examination. Examine the abdomen with the examinee supine, as well as
standing to detect hernias.
b.
Methods. Use appropriate clinical laboratory, radiologic, and endoscopic
examinations to confirm a diagnosis.
12. Genitourinary System (Item 32 of DD-2808).
a.
General. All physical examinations shall search for evidence of Sexually
Transmitted Infections (STI) or malformation.
b.
Instructions for examination according to sex.
(1) Females. The examination shall include:
(a) Inspection of the external genitalia.
(b) Either a vaginal or rectal bimanual palpation of the pelvic organs.
(c) Papanicolaou (PAP) testing and visualization of the cervix and
vaginal canal by speculum in accordance with 20.f. of this section.
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COMDTINST M6000.1E
(2) Males. The glans penis and corona will be exposed. The testes and
scrotal contents will be palpated and the inguinal lymph nodes will be
examined for abnormalities. Palpate the inguinal canals while having
the patient perform a valsalva.
13. Extremities (Item 33, 34, 35 of DD-2808). Carefully examine the extremities
for deformities, old fractures and dislocations, amputations, partially flexed or
ankylosed joints, impaired functions of any degree, varicose veins, and edema.
In general the examination shall include:
a. Elbow. With the examinee holding the upper arms against the body with the
forearms extended and fully supinated, observe for the presence of normal
carrying angle. Have the examinee flex the elbows to a right angle and
keeping the elbows against the body, note ability to fully supinate and
pronate the forearms. Test medial and lateral stability by placing varus and
valgus strain on the joint with the elbow extended. Test the power of the
flexor, extensor, supinator, and pronator muscles by having the examinee
contract these muscles against manual resistance. If indicated, x-rays should
include antero-posterior and lateral views.
b. Foot.
(1) Examine the feet for conditions such as flatfoot, corns, ingrown nails,
bunions, deformed or missing toes, hyperhidrosis, color changes, and
clubfoot.
(2) When any degree of flatfoot is found, test the strength of the feet by
requiring the examinee to hop on the toes of each foot for a sufficient
time and by requiring the examinee to alight on the toes after jumping
up several times. To distinguish between disqualifying and
nondisqualifying degrees of flatfoot, consider the extent, impairment of
function, appearance in uniform, and presence or absence of symptoms.
Remember, it is usually not the flatfoot condition itself that causes
symptoms but an earlier state in which the arches are collapsing and the
various structures are undergoing readjustment of their relationships.
Report angles of excursion or limitation; comparative measurements;
use of orthotics or other supports; and x-ray results if indicated.
c. Hip.
(1) With the examinee standing, observe the symmetry of the buttocks, the
intergluteal clefts, and infragluteal fold. Palpate the iliac crest and
greater trochanters for symmetry.
(2) If abnormalities are suspected, have the examinee stand first on one
foot and then the other, flexing the nonweight bearing hip and knee and
observing for ability to balance as well as for instability of the joint, as
indicated by dropping downward of the buttock and pelvis of the flexed
(non-weight bearing) hip. A positive Trendelenburg sign necessitates
x-ray evaluation.
Chapter 3. C. Page 12
COMDTINST M6000.1E
(3) While supine have the examinee flex the hip, abduct and adduct the hip
and rotate the leg inward. Observe for hesitancy in performing these
motions, incomplete range of motion, or facial evidence of pain on
motion. Test muscle strength in each position.
(4) With examinee prone, test for ability to extend each leg with knee
extended and test for power in each hip in extension.
(5) If abnormalities are detected requiring x-rays, obtain an anteroposterior and a lateral view of each hip for comparison.
d. Knee.
(1) With trousers (skirt/dress), shoes, and socks removed, observe general
muscular development of legs, particularly the thigh musculature.
(2) Have examinee squat, sitting on heels, and observe for hesitancy,
weakness, and presence or absence of pain or crepitus.
(3) With examinee sitting, test for ability to fully extend the knee and test
power in extension by applying pressure to the lower leg with knee
extended. Compare equality of power in each leg. With knee flexed,
test for hamstring power by attempting to pull leg into extension;
compare equality of strength in each leg. Palpate entire knee for
tenderness. With examinee still sitting on the table edge, sit and grasp
the heel between the knees; then test for cruciate ligament stability by
first pulling the tibia anteriorly on the femur and by then pushing the
tibia posteriorly on the femur ("Drawer Sign").
(4) With the examinee supine, mark on each leg a distance of 1 inch above
the patella and 6 inches above the patella, making sure this is done with
muscles relaxed. Measure circumferences at these levels and note
presence or absence of atrophy. Test the medial and lateral collateral
ligaments by placing varus and valgus strain on the extended knee.
Manipulate the knee through a complete range of flexion and extension,
noting any difference between the sides and any abnormal restriction.
(5) If there is a history of knee injury assess muscular strength, ligamentous
stability, and range of motion. Also look for evidence of inflammatory
or degenerative processes.
(6) In the presence of any history of "locking," recurrent effusion, or
instability, or when atrophy measured is more than 3/8 inch or when
limitation of motion or ligamentous instability is detected, obtain x-rays
including an antero-posterior, lateral, and intercondylar view.
(7) An orthopedic evaluation is required on all recruit physicals if there is
evidence of any abnormality.
Chapter 3. C. Page 13
COMDTINST M6000.1E
e. Shoulder.
(1) With the examinee stripped to the waist, inspect both anteriorly and
posteriorly for asymmetry, abnormal configuration, or muscle atrophy.
(2) From the back, with the examinee standing, observe the
scapulohumeral rhythm as the arms are elevated from the sides directly
overhead, carrying the arms up laterally. Any arrhythmia may indicate
shoulder joint abnormality and is cause for particularly careful
examination. Palpate the shoulders for tenderness and test range of
motion in flexion, extension, abduction, and rotation. Compare each
shoulder in this respect.
(3) Test muscle power of abductors, flexors, and extensors of the shoulder,
as well as power in internal and external rotation. Have the examinee
attempt to lift a heavy weight with arms at the side to establish integrity
of the acromioclavicular joint.
f.
Wrist and Hand.
(1) Palpate the wrist for tenderness in the anatomical snuff box often
present in undiscovered fractures of the carpal navicular. Observe and
compare muscle strength and range of motion, flexion, extension,
radial, and ulnar deviation.
(2) Inspect the palms and extended fingers for excessive perspiration,
abnormal color or appearance, and tremor, indicating possible
underlying organic disease.
(3) Have the examinee flex and extend the fingers making sure
interphalangeal joints flex to allow the finger tips to touch the flexion
creases of the palm.
(4) With the hands pronated, observe the contour of the dorsum of the
hands for atrophy of the soft tissues between the metacarpals seen in
disease or malfunction of peripheral nerves.
(5) With the fingers spread, test for strength, and interosseous muscle
function by forcing the spread fingers against the resistance of the
examinee.
(6) If indicated, obtain antero-posterior and lateral x-rays of the wrist, as
well as antero-posterior and oblique views of the hand.
14. Spine and Other Musculoskeletal (Item 36 of DD-2808). Carefully examine for
evidence of intervertebral disc syndrome, myositis, and traumatic lesions of the
low back (lumbosacral and sacroiliac strains). If there is any indication of
congenital deformity, arthritis, spondylolisthesis, or significant degree of
curvature, obtain orthopedic consultation and x-rays.
a.
Examination. With the examinee stripped and standing, note the general
configuration of the back, the symmetry of the shoulders, iliac crests and
Chapter 3. C. Page 14
COMDTINST M6000.1E
hips, and any abnormal curvature. Palpate the spinous processes and the
erector spinae muscle masses for tenderness. Determine absence of pelvic
tilt by palpating the iliac crests. Have examinee flex and extend spine and
bend to each side, noting ease with which this is done and the presence or
absence of pain on motion. Test rotary motion by gripping the pelvis on
both sides and having the examinee twist to each side as far as possible.
b.
Reflexes. With the examinee sitting on the examining table, test patellar
and ankle reflexes and fully extend the knee, note complaints of pain (this
corresponds to a 90 degree straight leg raising test in supine position).
c.
Strength. With the examinee supine, test dorsiflexor muscle power of the
foot and toes, with particular attention to power of the extensor hallucis
longus. Weakness may indicate nerve root pressure on Sl. Flex hip fully on
abdomen and knee flexed and determine presence or absence of pain on
extremes of rotation of each hip with hip flexed to 90 degrees. Frequently,
in lumbosacral sprains of chronic nature, pain is experienced on these
motions. Place the heel on the knee of the opposite extremity and let the
flexed knee fall toward the table. Pain or limitation indicates either hip
joint and/or lumbosacral abnormality.
d.
Extension. While prone, have the examinee arch the back and test strength
in extension by noting the degree to which this is possible.
e.
Abnormal findings. If pain is experienced on back motions in association
with these maneuvers or if there is asymmetry or abnormal configuration,
back x-rays, including pelvis, should be obtained. These should include
antero-posterior, lateral, and oblique views.
15. Identifying Body Marks, Scars, and Tattoos (Item 37 of DD-2808).
a.
Examination. Carefully inspect the examinee's body, front and rear, on
each side of the median line separately, commencing with the scalp and
ending at the foot. Record under the "Notes" section on the face of the DD2808 all body marks, tattoos, and scars useful for identification purposes.
Also state if no marks or scars are found.
b.
Description of Body Marks, Scars, and Tattoos.
(1) Indicate the size, location, and character of scars, moles, warts,
birthmarks, etc.
(2) When recording the location of a tattoo, include narrative description of
the design. Tattoo transcriptions of words or initials shall be recorded
in capital letters. Describe the size of a tattoo regarding its general
dimensions only. A statement relative to color or pigment is not
required.
(3) Note amputations and losses of parts of fingers and toes showing the
particular digit injured and the extent or level of absence.
Chapter 3. C. Page 15
COMDTINST M6000.1E
c.
Abbreviations for Body Marks, Scars, and Tattoos.
(1) The following are authorized abbreviations for the descriptions or
conditions indicated:
Amp.- amputation
f. -flat
fl. -fleshy
s. -scar smooth
v. -vaccination
m. - mole
p. -pitted
r. -raised
l. -linear
o. -operative
w. -wart
VSULAvaccination scar
upper left arm
h. -hairy
(2) Combinations of the above abbreviations are permissible: p.s. 1/2d. pitted scar 1/2 inch diameter, f.p.s. lxl/2 - flat pitted scar l inch long and
1/2 inch wide, r.h.m. 1/4d. - raised hairy mole 1/4 inch diameter.
(3) Do not use abbreviations when describing tattoos since they are likely
to be mistaken as signifying tattooed letters.
16. Neurologic (Item 39 of DD-2808). Conduct a careful neurological examination
being attentive to the following:
a.
Gait. The individual shall: walk a straight line at a brisk pace with eyes
open, stop, and turn around. Look for spastic, ataxic, incoordination, or
limping gait, absence of normal associated movements, deviation to one
side or the other, the presence of abnormal involuntary movement, undue
difference in performance with the eyes open and closed.
(1) Stand erect, feet together, arms extended in front. Look for
unsteadiness and swaying, deviation of one or both of the arms from
the assumed position, tremors, or other involuntary movements.
(2) Touch the nose with the right and then the left index finger, with the
eyes closed. Look for muscle atrophy or pseudohypertrophy, muscular
weakness, limitation of joint movement, and spine stiffness.
b.
Pupils. Look for irregularity, inequality, diminished or absent contraction
to light or lack of accommodation.
c.
Deep Sense (Romberg). Negative, slightly positive, or pronouncedly
positive.
d.
Deep Reflexes: Patellar, Biceps, etc. Record as absent (o), diminished (-),
normal (+), hyperactive (++), and exaggerated (+++).
e.
Sensory Disturbances. Examine sensation by lightly pricking each side of
the forehead, bridge of the nose, chin, across the volar surface of each wrist,
and dorsum of each foot. Look for inequality of sensation right and left. If
these sensations are abnormal, vibration sense should be tested at ankles
and wrists with a tuning fork. With eyes closed, the examinee shall move
each heel down the other leg from knee to ankle. Test sense of movement
of great toes and thumb. Look for diminution or loss of vibration and
Chapter 3. C. Page 16
COMDTINST M6000.1E
plantar reflexes. When indicated, perform appropriate laboratory tests and
x-ray examinations.
f.
Motor Disturbances. Evidence of muscle weakness, paresis, or any other
abnormality.
g.
Muscular Development. Evidence of atrophy, compensatory hypertrophies,
or any other abnormality.
h.
Tremors. State whether fine or coarse, intentional or resting, and name
parts affected.
i.
Tics. Specify parts affected. State whether they are permanent or due to
fatigue or nervous tension.
j.
Cranial Nerves. Examine carefully for evidence of impaired function or
paresis. Remember that some of the cranial nerves are subject to frequent
involvement in a number of important diseases, such as syphilis, meningitis,
encephalitis lethargica, and injuries to the cranium.
k.
Psychomotor Tension. Test the ability to relax voluntarily by having the
examinee rest the forearm upon your palm then test the forearm tendon
reflexes with a percussion hammer.
l.
Peripheral Circulation. Examine for flushing, mottling, and cyanosis of
face, trunk, and extremities. Question as to the presence of localized
sweating (armpits and palms) and cold extremities. Carefully study any
abnormalities disclosed on the neurological examination and express an
opinion as to their cause and significance and whether they are sufficient
cause for rejection.
17. Psychiatric (Item 40 of DD-2808).
a. Personality Evaluation. In order to evaluate the adequacy of the examinee's
personality for adjustment to the conditions of military service:
(1) Estimate the examinee's capacity coupled with real respect for
personality and due consideration for feelings.
(2) Conduct the examination in private to encourage open and honest
answers.
(3) Attempt to discover any difficulties that the examinee may have had
with interpersonal relationships at work or during leisure activities.
b. Diagnosis of Psychiatric Disorders. The diagnosis of most psychiatric
disorders depends upon an adequate longitudinal history, supplemented by
information obtained from other sources, such as family, physicians,
schools, churches, hospitals, social service or welfare agencies, and courts.
Chapter 3. C. Page 17
COMDTINST M6000.1E
c. Telltale Signs of Psychiatric Disorders. Be watchful for any of the
following: inability to understand and execute commands promptly and
adequately, lack of normal response, abnormal laughter, instability,
seclusiveness, depression, shyness, suspicion, over boisterousness, timidity,
personal uncleanliness, stupidity, dullness, resentfulness to discipline, a
history of enuresis persisting into late childhood or adolescence, significant
nail biting, sleeplessness or night terrors, lack of initiative and ambition,
sleep walking, suicidal tendencies, whether bona fide or feigned. Abnormal
autonomic nervous system responses (giddiness, fainting, blushing,
excessive sweating, shivering or goose flesh, excessive pallor, or cyanosis
of the extremities) are also occasionally significant. Note also the lack of
responses as might reasonably be expected under the circumstances.
d. Procedures for Psychiatric Examination.
(1) Mental and personality difficulties are most clearly revealed when the
examinee feels relatively at ease. The most successful approach is one
of straightforward professional inquiry, coupled with real respect for
the individual's feelings and necessary privacy. Matters of diagnostic
significance are often concealed when the examinee feels the
examination is being conducted in an impersonal manner or without
due concern for privacy.
(2) Pay close attention to the content and implication of everything said and
to any other clues, in a “matter-of-fact manner”. Follow-up whatever is
not self evident or commonplace.
e. Aviation only. Although this phase of the examination is routinely
performed only on candidates for flight training, it may be made part of any
aviation physical examination. The objective is to determine the examinee's
basic stability, motivation, and capacity to react favorably to the special
stresses encountered in flying. Report any significant personality change in
an experienced aviator. Following the completion of the general
examination:
(1) Study carefully the examinee's family history.
(2) Determine the family's attitude towards flying and the examinee's
reaction to the stresses of life in general and emotional response and
control.
18. Endocrine System. Evaluate endocrine abnormalities during the general clinical
examination. Palpate the thyroid for abnormality and observe the individual for
signs of hyperthyroidism or hypothyroidism. Observe general habitus for
evidence of endocrine dysfunction.
19. Dental (Item 43 of DD-2808).
a.
Who May Conduct Dental Examinations.
Chapter 3. C. Page 18
COMDTINST M6000.1E
(1) For Academy, OCS, and direct commission applicants: a Uniformed
Services Dental Officer.
(2) For all aviation, diving, and overseas/sea duty physical examinations: a
Uniformed Services Dental Officer or a contract dentist.
(3) For all others: a Uniformed Services dental officer, a contract dentist,
or a medical examiner if a dentist is unavailable.
b.
Procedures for Conducting Dental Examinations.
(1) Applicants for Original Entry. Whenever practical, applicants for
original entry into the Service shall be given a Type II dental
examination. Otherwise, the Dental Officer shall determine the type of
examination that is appropriate for each examinee.
(2) Active Duty Personnel. Members on active duty, who are assigned to
locations where CG, USMTF, or civilian contract dental clinics are
available, shall be required to have an annual Type II dental
examination.
(3) Reserve Personnel.
(a) Type II dental examination is required annually for all SELRES.
1. Members who are unable to be screened by a CG or DOD
Dental Clinic or who do not participate in the TRICARE
Dental Plan or have private dental insurance may use a civilian
dentist provided they follow HSWL SC direction.
2. HSWL SC is authorized to provide payment of SELRES dental
exams obtained from civilian sources. Payment for dental
cleaning and follow-up care is not authorized.
3. The results from dental exams provided by DOD or civilian
dentists shall be submitted on an Active Duty Reserve Forces
Dental Examination, DD Form 2813.
c. Dental Restorations and Prostheses. The minimum number of serviceable
teeth prescribed for entry in various programs of the Service is predicated on
having retentive units available to provide for the reception of fixed bridges
or partial dentures that may be necessary for satisfactory masticatory or
phonetic function. Prostheses already present should be well-designed,
functional, and in good condition.
20. Laboratory Findings.
a.
Required Tests. Personnel undergoing physical examinations are required
to have the following tests performed, except where obtaining them is not
possible or expeditious, or incurring charges for them is not authorized. In
such cases, these tests shall be obtained at the first duty station where
Chapter 3. C. Page 19
COMDTINST M6000.1E
facilities are available. All Labs must be performed within 180 days of the
physical exam or they will be considered out of date. The normal values
listed below are for guidance. Abnormal laboratory values alone are not
disqualifying; however, the causative underlying condition may be.
Minimal deviations may not require further evaluation and this should be
noted as NCD (not considered disqualifying) in item 74 by the examiner.
Normal variants should be noted as such.
b.
Hematology/Serology.
(1) Hematology. Perform a hemoglobin (HGB) or hematocrit (HCT) on all
examinees. Perform other hematological studies only as indicated.
(a) Hemoglobin - Males 13-18 gm/100ml Females 11.7-16 gm/100ml.
(b) Hematocrit - Males 40-54%, Females 35-47%.
If any of these parameters are abnormal, an RBC and indices shall be
done. Normal indices are:
RBC-Males
4.3 to 6.2 million
Females
3.8 to 5.4 million
MCV82-92 cubic microns
MCH27-32 picograms
MCHC - 30-36%
(2) Serological Test for Syphilis (RPR/STS).
(a) Required for all aviation physicals and diving candidate physicals.
(b) Unless there is a documented history of adequately treated syphilis,
all examinees testing positive shall have repeat testing three or
more days later. Ensure that at the time of obtaining serum the
examinee neither has, nor is convalescing from, any acute
infectious disease or recent fever. If available at no charge, the
facilities of local or state health departments may be used for
performing serological tests. Examinees with a history of treated
syphilis should have declining or low titer positive reaction.
(c) If the second test is positive then obtain an FTA/ABS. If the
FTA/ABS is positive, further evaluation may be required to
determine the appropriate therapy.
(d) Several conditions that are known to give false RPR/STS are
infectious mononucleosis, malaria, yaws, pinta, chicken pox,
infectious hepatitis, immunization, and atypical pneumonia. The
cause of a false positive serological test for syphilis should be
explored since many diseases giving a false positive are also
disqualifying.
(e) New diagnosis of syphilis requires disease reporting per local
governmental requirements and IAW Chapter 7-B-3 of this
Manual.
Chapter 3. C. Page 20
COMDTINST M6000.1E
(f) Diagnosis of syphilis requires testing for other sexually transmitted
infections (gonorrhea, chlamydia, HIV and Hepatitis B).
(3) Sickle Cell Preparation Test. Applicants for aviation and diving
training shall be tested for sickling phenomenon, if not previously
tested. Evaluate positive sickledex results by a quantitative
hemoglobin electrophoresis. Greater than 40 percent Hbs is
disqualifying for aviation and diving. Once the test has been
completed, the results will be filed in the health record and recorded on
the Problem Summary List. This is a one time test that never needs to
be repeated and the results shall be filed in the health record.
(4) Lipid Testing.
(a) Lipid screening should be performed based upon the Clinical
Preventive Services guidelines as contained in CG Periodic Health
Assessment, COMDTINST 6150.3.
(5) HIV Antibody.
(a) All HIV testing should be performed in accordance with the Coast
Guard Human Immunodeficiency Virus (HIV) Program, COMDTINST
6230.9.
(6) Tuberculosis (TB) Surveillance/Screening. CG members are required
to have a baseline Tuberculin skin test (TST) or Quantiferon Gold Test
(QFT) per the Centers for Disease Control and Prevention (CDC)
guidance. No group of CG personnel is at high risk for TB.
Individuals whose duties include alien migrant interdiction, marine
safety operations, and health care personnel are not at increased risk
unless they work in facilities that regularly care for persons with active
TB disease. Therefore, periodic screening for TB is not warranted.
Members whose last recorded TST reaction was reactive shall be
screened during the PHA for indicators of active disease. This involves
reviewing the HR and asking the member about the following:
persistent and/or productive cough (especially coughing up blood),
chest pain, fever, chill, night sweats, appetite loss, and unintended
weight loss. Routine evaluation of old TST reactors by chest radiograph
is not authorized nor warranted. A Medical Officer may order a TST
and/or chest radiograph on a patient with clinical signs/symptoms of
active TB or an individual TST on a patient with risk factors listed
below:
(a) Close contacts of persons known or suspected to have active TB
(sharing the same household or other enclosed environments).
(b) Foreign-born persons from areas where TB is common (Asia,
Africa, Latin America, Eastern Europe, Russia).
Chapter 3. C. Page 21
COMDTINST M6000.1E
http://www.cdc.gov/tb/education/Mantoux/guide.htm.
c.
Chest X-ray (Item 52 of DD-2808).
(1) Will be accomplished as part of the physical examinations for
application for aviation or diving programs. Chest X-rays previously
performed within eighteen (18) months of application, with normal
results, are acceptable if there is no change in clinical presentation.
(2) Will not be performed for routine screening purposes without a prior
clinical evaluation and a specific medical indication. The Senior
Medical Executive may authorize an exception to this policy when
there are obvious medical benefits to be gained by routine screening xray examination (e.g., Asbestos Medical Surveillance Program). Such
exceptions should be authorized only after careful consideration of the
diagnostic yield and radiation risk of the x-ray study, as well as other
significant or relevant costs or social factors. X-ray examinations will
not be ordered solely for medical-legal reasons.
d.
Electrocardiogram (Item 52 of DD-2808).
(1) Electrocardiograms (ECG) shall be accomplished routinely on the
following individuals:
(a) Those in whom medical history or clinical findings are suggestive
of cardiac abnormalities.
(b) Examinees with a sitting pulse rate of less than 50 or more than
100.
(c) Applicants for aviation and diving training.
(d) All designated aviation personnel every four (4) years until age 40,
then biennially. For designated aviation personnel on physical
examinations where no EKG is required, place the date and results
of the last EKG in block #52 (Other) of Report of Medical
Examination, DD-2808.
(2) All student and designated aviation personnel shall have an ECG on file
in their health record.
(3) All tracings will be compared to the baseline reading in the health
record, if one is present. If significant changes are present, obtain a
cardiac consultation. A report of the consult shall be submitted for
Chapter 3. C. Page 22
COMDTINST M6000.1E
review along with the DD-2808. It is imperative then that proper
techniques for recording the ECG be followed.
(a) The routine ECG will consist of 12 leads, namely standard leads 1,
2, 3, AVR, AVL, AVF, and the standard precordial leads V1
through V6.
(b) Take care to properly place the precordial electrodes. It is
important that the electrodes across the left precordium are not
carried along the curve of the rib but are maintained in a straight
line. Be particular in placing the first precordial lead so as to avoid
beginning placement in the third interspace rather than the fourth.
Do not smear electrode paste from one precordial position to
another. Include a standardization mark on each recording.
e.
Urinalysis. A urinalysis is required on all physical examinations. The urine
shall be tested for specific gravity, glucose, protein, blood, leukocyte
esterase, and nitrite by an appropriate dipstick method. A microscopic
examination is required only if any of these dipstick tests is abnormal.
(1) Specific Gravity. Normal values are 1.005-1.035. Specific gravity
varies with fluid intake, time of day, climate, and medication. As a
rule, elevation of the specific gravity reflects only the state of
hydration, while a low specific gravity may reflect kidney disease. In
evaluating abnormalities, a repeat is generally sufficient, provided the
factors above are considered and explained to the individual. Where
possible, the repeat should be a first morning specimen which is usually
the most concentrated.
(2) Glucose. Any positive test is abnormal. A false positive for glucose
may occur in individuals who take Vitamin C or drink large quantities
of fruit juice. As soon as practical after discovery of the glycosuria,
obtain a fasting blood glucose. If glycosuria persists or if the fasting
blood glucose exceeds 125 mg/100 ml, evaluate the individual for
diabetes.
(3) Protein. A trace positive protein is often associated with a highly
concentrated (specific gravity 1.024 or greater) early morning specimen
and is considered normal and need not be repeated. A one plus or
greater protein, or a trace positive in the presence of a dilute urine,
should be evaluated by a 24-hour specimen (normal range 10-200 mg
protein/24 hours).
(4) Microscopic.
(a) Normal:
0-5 WBC
0-5 RBC (clean catch specimen)
Occasional epithelial cells (more may be normal
Chapter 3. C. Page 23
COMDTINST M6000.1E
in an otherwise normal urinalysis)
No casts occasional bacteria
(b) Pyuria usually indicates an infection or improper collection
techniques. Appropriate follow-up is required, including a repeat
after the infection has cleared.
(c) Hematuria may normally occur following heavy exercise or local
trauma and as a false positive in menstruating females. It always
requires evaluation with the minimum being a repeat showing no
hematuria.
(d) Casts, heavy bacteria, other organisms, and abnormal cells require
further evaluation.
f.
PAP Test (Item 52 a. of DD-2808).
(1) A PAP test is required at the following times on female members:
(a) On the pre-training physical examination at time of initial entry
into the CG.
(b) In accordance with the Clinical Preventive Services guidelines as
contained in CG Periodic Health Assessment, COMDTINST
6150.3.
(2) PAP tests and pelvic examinations (by civilian or military practitioners)
that have been performed within one year of periodic examinations are
acceptable. In any case, results of the pelvic examination and PAP test
will be recorded in Item 52 a. The practitioner is responsible for
communicating the result of the PAP smear (either positive or negative)
to the patient.
(3) To reduce false-negative smears, endocervical sampling shall be done
using a cytobrush, provided no contraindication is present (as in
pregnancy or cervical stenosis). Laboratories to which smears are sent
for interpretation must, as a matter of routine, indicate on their reports
whether endocervical sampling was adequate. Where endocervical cell
sampling is reported as inadequate, the smear shall be repeated.
g.
Pulmonary Function Test (PFT). Perform a PFT on all applicable
Occupational Medical Surveillance and Evaluation Program (OMSEP)
examinations and when clinically indicated.
(1) Screening spirometry should not be performed if the subject falls into
one of the following catagories:
(a) Is acutely ill from any cause.
Chapter 3. C. Page 24
COMDTINST M6000.1E
(b) Has smoked or used an aerosolized bronchodilator within the past
hour.
(c) Has eaten a heavy meal within the previous two hours.
(d) Has experienced an upper or lower respiratory tract infection
during the past three weeks.
(e) Administer the PFT by following the manufacturers’ instructions.
FIGURE 3-C-1
SPIROMETRIC
GUIDELINES
NORMAL
MILD TO
MODERATE
SEVERE
OBSTRUCTIVE DISEASE
RESTRICTIVE
DISEASE FCV%
FEV-1/FVC
FCV PREDICTED
> 0.69
> .80
0.45 -0.69
0.51-0.80
< 0.45
<0.51
h. Special Tests. In some cases, information available should be supplemented
by additional tests or diagnostic procedures (eye refractions, x-rays, repeated
blood pressure readings, etc.), in order to resolve doubts as to whether the
examinee is or is not physically qualified. If facilities are available to
perform such tests at no cost, they should be obtained as indicated in
individual cases. Otherwise, applicants for original entry in the Service will
be required to obtain such tests at their own expense, if they desire further
consideration.
i. Laboratory Values (OMSEP). All laboratory values not previously discussed
but that accompany a physical examination (e.g., chemistry profiles, etc.,)
must have accompanying normals for the laboratory that performed the tests.
j. Mammography. Breast cancer screening via mammography should be
performed in accordance with the Clinical Preventive Services guidelines
as continue in CG Periodic Health Assessment, COMDTINST 6150.3.
Results should be documented on the routine physical exams. Mammograms
done between the required screening ages can be used to satisfy the periodic
requirement. This judgment is left to the practitioner. If mammography is
not done at the required ages, the reason must be supplied in item 73 of the
Report of Medical Examination, DD-2808 and should include date and result
Chapter 3. C. Page 25
COMDTINST M6000.1E
of the last mammogram. Practitioners are responsible for communicating
mammography results (either positive or negative) to the patient.
k. Glucose-6-Phosphate Dehydrogenase (G-6-PD). Qualitative testing (present
or not) for G-6-PD deficiency is required for all AD and SELRES
members. The results of testing shall be annotated on the Adult Preventive
and Chronic Care Flowsheet, DD-2766 as well as in MRRS. Once testing is
accomplished, it need never be repeated.
21. Height, Weight, and Body Build.
a. Height. Measure the examinee's height in both meters and to the nearest
inch, without shoes.
b. Weight.
(1) Weights are with underwear/undergarments only.
(2) Weigh the examinee on a standard set of scales calibrated and accurate.
Record the weight both kilograms and pounds. Do not record fractions
of pounds, such as ounces.
c. Frame Size. Using a cloth tape, measure the wrist of the dominant hand,
measure all the way around from lateral to medial styloid process. Measure
in centimeters and inches including fraction of inches.
d. Body Fat Percentage. Determined by MEPS.
22. Distant Visual Acuity and Other Eye Tests.
a.
Distant Visual Acuity, General. Visual defects are one of the major causes
for physical disqualification from the armed services. Methods of testing
vision have varied greatly among the armed services and from place to
place in each Service. Consequently, visual test results are not always
comparable. An examinee presenting for examination at one place might be
qualified for visual acuity, while at another place, disqualified. Although
this is an undesirable situation, no practical solution, such as prescribing
standards for equipment and conditions (room size, ventilation, paint colors,
room illumination, etc.), is available to the CG as the examinations are
obtained from various sources over which the CG has no control. It is
therefore imperative that examiners be especially painstaking to obtain the
most accurate results possible.
b.
Examination Precautions.
(1) Make every effort to conduct the examination when the examinee is in
normal physical condition. Follow the examination routine in the order
prescribed in the following instructions. Record the vision for each eye
when determined so that errors and omissions will be avoided.
Chapter 3. C. Page 26
COMDTINST M6000.1E
(2) It may be extremely difficult to obtain an accurate measure of visual
acuity. Bear in mind those individuals who are anxious to pass visual
acuity tests may resort to deception. Similarly, other individuals may
attempt to fail a visual acuity test to avoid undesirable duties. Hence,
be prepared to cope with either possibility in order to uncover and
recognize visual defects without the cooperation of the person being
tested.
(3) Refer uncooperative examinees to a Medical Officer.
c.
Examination Procedures.
(1) In order to obtain a more valid evaluation, inform examinees that
contact lenses will not be worn during the evaluation and for 72 hours
before. Orthokeratotic lenses shall be removed for 14 days or until
vision has stabilized for 3 successive examinations.
(2) If the examinee wears glasses, they must be removed before entering
the exam room. Test each examinee without unnecessary delay after
entering the examining room. In order to prevent personnel from
memorizing the charts, permit only one examinee to view the test
charts at a time. Ensure other examinees cannot hear the examination.
(3) Follow manufactures instructions on how to conduct a visual acuity test
for the piece of equipment you are using. Visual acuity may also be
determined with the Armed Forces Vision Tester (AFVT). Follow
manufactures instruction on how to administer this test.
d.
Score recording. Record vision test scores as a fraction in that the upper
number is the distance in feet from the chart and the lower number is the
value of the smallest test chart line read correctly. Thus, a person reading at
a distance of 20 feet, the 30 foot test chart line is given a score of 20/30.
20/20 indicates that a person reads at a distance of 20 feet the test chart line
marked 20. Similarly, 20/200 means a person can read at a distance of 20
feet only the test chart line marked 200.
e.
Refraction.
(1) Eye refractions are required:
(a) When applying for flight training (SNA) (This must include
cycloplegic.).
(b) When visual acuity falls below 20/20 in either eye (near or distant).
(2) Subsequent refractions are required only if the visual acuity deteriorates
further.
(3) If a cycloplegic is used during the course of refraction, then the
examinee must wear dark glasses until the effects disappear. The
Chapter 3. C. Page 27
COMDTINST M6000.1E
installation of 1 drop into each eye of 1% solution of pilocarpine
hydrochloride in distilled water after completing the examination will
constrict the pupil and thus relieve the photophobia.
f.
Near Vision. Test near vision on all examinees and record results in Item
61 of DD-2808 using Snellen notations. The examinee should be
positioned so that the light source is behind him/her and the near vision test
card is well illuminated. See manufacturer’s instructions on how to
administer the test. Record near vision both with and without corrective
lenses if glasses are worn or required. Record corrections worn in Item 73.
See the chart below for conversion from the various near point letter
nomenclatures to Snellen notations.
CONVERSION TABLE FOR VARIOUS NEAR POINT LETTER
NOMENCLATURE
Standard Test
Chart
Snellen
English Linear
Snellen Metric
Jaegar
14/14
20/20
0.50
J-1
14/17.5
20/25
.62
J-2
14/21
20/30
.75
J-4
14/28
20/40
1.00
J-6
14/35
20/50
1.25
J-8
14/49
20/70
1.75
J-12
14/70
20/100
2.25
J-14
14/140
20/200
g.
Heterophoria.
(1) Except for aviation personnel, special tests for heterophoria are not
required unless medically indicated.
(2) Heterophoria is a condition of imperfect muscle balance in which the
eyes have a constant tendency to deviate and latent deviation is
overcome by muscular effort (fusion to maintain binocular single
vision). Fusion is responsible for the two eyes working together in
harmony and when anything prevents this, fusion is disrupted and one
eye deviates. Since heterophoria is only a tendency of the eyes to
deviate, no actual deviation is apparent when the eyes are being used
Chapter 3. C. Page 28
COMDTINST M6000.1E
together under ordinary conditions. The deviation becomes visible
only when fusion control is weakened or abolished. When deviation
occurs, its exact amount can be estimated with some accuracy by
neutralizing the deviation with prisms of varying strength. If the eye
deviates toward its fellow, the deviation is known as esophoria; if it
deviates away from its fellow, the deviation is known as exophoria; if it
deviates up or down, the deviation is known as hyperphoria. The
condition of perfect muscle balance (no deviation) is orthophoria.
(3) The vertical and horizontal phorias may be tested with the Phoropter or
AFVT.
h. Accommodation. There is no requirement to test accommodation unless
medically indicated.
i.
Color Perception Tests. Examinees are qualified if they pass either the
Pseudoisochromatic Plates (PIP) or the Farnsworth Lantern (FALANT) test.
The testing for color vision must be unaided or with standard corrective
lenses only. Use of any lenses (such as Chromagen) or other device to
compensate for defective color vision is prohibited. Examinees may be
found qualified, "on record", if a previous certified physical examination
has a passing PIP or FALANT score available for review. Exception: At
the time of accession medical screening (e.g. CG Academy (including
cadets and OCS candidates), Cape May recruits) the PIP color vision test
will be repeated and normal color vision confirmed under controlled
conditions as described below. Examinees failing the PIP will be
administered the FALANT test. Examinees who fail the PIP are qualified if
they pass the FALANT.
(1) Farnsworth Lantern Test (FALANT).
(a) Administration and Scoring.
1
Instruct the examinee: "The lights you will see in this lantern
are either, red, green, or white. They look like signal lights at
a distance. Two lights are presented at a time--in any
combination. Call out the colors as soon as you see them,
naming first the color at the top and then the color at the
bottom. Remember, only three colors--red, green, and white-and top first”.
2
Turn the knob at the top of the lantern to change the lights;
depress the button in the center of the knob to expose the
lights. Maintain regular timing of about two seconds per
exposure.
Chapter 3. C. Page 29
COMDTINST M6000.1E
3
Expose the lights in random order, starting with RG or GR
combinations (Nos. 1 or 5), continuing until each of the 9
combinations have been exposed.
4
If no errors are made on the first run of nine pairs of lights, the
examinee passes.
5
If any errors are made on the first run, give two more complete
exams with one done in the opposite direction (to prevent
memorization). Passing score is at least 16 out of 18 correct
for the two runs.
6
An error is considered the miscalling of one or both of a pair
of lights; if an examinee changes responses before the next
light is presented, record the second response only.
7
If an examinee uses glasses for distance, they shall be worn.
8
If an examinee says "yellow," "pink," etc., state, "There are
only 3 colors--red, green, and white”.
9
If an examinee takes a long time to respond, state, "As soon as
you see the lights call them”.
(b) Operation of Lantern.
1
Give the test in a normally lighted room, screen from glare,
exclude sunlight. The examinee should face the source of
room illumination.
2
Test only one examinee at a time (do not allow others to
watch).
3
Station the examinee 8 feet from the lantern.
4
The examinee may stand or sit, tilt the lantern so that the
aperture in the face of the lantern is directed at examinee's
head.
(2) Pseudoisochromatic Plates (PIP). When Pseudoisochromatic Plates are
used to determine color perception, a color vision test lamp with a
daylight filter or a fluorescent light with a daylight tube shall be used
for illumination. Do not allow the examinee to trace the patterns or
otherwise touch test plates. Show the plates at a distance of 30 inches
and allow 2 seconds to identify each plate. If the examinee hesitates,
state "read the numbers." If the examinee fails to respond, turn to the
next plate without comment. Qualification is ascertained as follows:
Chapter 3. C. Page 30
COMDTINST M6000.1E
(a) 20 plate test set. Examinee must correctly read at least 17,
excluding demonstration plates.
(b) 18 plate test set. Examinee must correctly read at least 14
excluding demonstration plates.
(c) 15 plate test set (one demo). Examinee must correctly read10
plates.
j.
Depth Perception. Depth perception may be determined by the Armed
Forces Vision Tester (AFVT) or OPTEC 2300, the Random Dot Circles
Test (RANDOT), or the Titmus Graded Circles Stereo Acuity Test
(TITMUS). When doing a physical on the DD-2808, if you do not use the
AFVT, line through the pre-printed entry and record the test used with the
proper score. If you use the AFVT and then also use another depth
perception test, record the AFVT in block 67 and then record the additional
depth perception test findings in block 60 (other vision test) or block 73
(notes). Required for all aviation personnel and when medically indicated.
(1) If the AFVT or OPTEC 2300 is used, have the patient seated
comfortably. If the patient wears a habitual spectacle prescription they
may be tested without the prescription, but if they fail, retest with the
prescription. Test emulates distance test (optical infinity). Refer to
manual for correct settings for model being used. The following
guidelines must be adhered to when testing:
(a) Group A is for demonstration purposes only and should not be
used as part of the actual test (see manual).
(b) Group B is at the level of the new overall standard of 40 seconds of
arc, there are three presentations of five circles each within group
b. The patient identifies the circle within each presentation that
appears "closest".
(c) Patient must correctly identify all presentations within group b to
pass.
(d) You may test beyond group b if desired but it is not necessary.
Record as "AFVT group b - pass".
(e) If patient fails any in the group, retest using RANDOT and/or
Titmus below.
(2) RANDOT. If the patient wears habitual spectacle prescription they
may test without the prescription, but if the patient fails, retest with the
prescription. Polaroid spectacles may also be worn (over habitual
prescription if requested). Test distance is 40 cm (16 inches). Provide
adequate light but avoid reflections from the tests surface. Hold test
upright to maintain the proper axis of polarization. Do not permit the
patients head to tilt during testing. The following guidelines must be
adhered to when testing:
Chapter 3. C. Page 31
COMDTINST M6000.1E
(a) There are ten presentations of three circles each in the RANDOT,
you must test all ten presentations, do not stop after number seven.
(b) You must test all presentation in order, do not jump around since
each level is progressively more difficult.
(c) Patient identifies the circle that appears "closest".
(d) Test until the patient misses two levels in a row.
(e) Record the last level passed successfully.
(f) For RANDOT, a minimum passing score is correctly identifying
presentations 1 through 7 which equal 40 seconds of arc.
(g) Record as the number missed over the number possible. For
example, "RANDOT 3/10 pass" or "RANDOT 4/10 fail".
(h) If the patient fails the RANDOT, the patient may be retested using
AFVT / OPTEC 2300 or TITMUS.
(3) TITMUS. If the patient wears habitual spectacle prescription they may
test without the prescription, but if they fail, retest with the
prescription. Polaroid spectacles may also be worn (over habitual
prescription if requested). Test distance is 40 cm (16 inches). Provide
adequate light but avoid reflections from the tests surface. Hold test
upright to maintain the proper axis of polarization. Do not permit the
patients head to tilt during testing. The following guidelines must be
adhered to when testing:
(a) There are nine presentations of four circles each in the Titmus.
(b) You must test all nine presentations.
(c) You must test all presentations in order. Do not jump around since
each level is progressively more difficult.
(d) Patient identifies the circle that appears “closest”.
(e) Test until the patient misses two levels in a row (or the last
presentation).
(f) Record the last level passed successfully.
(g) For Titmus, a minimum passing score is correctly identifying all of
the presentation 1 through 9 which equals 40 seconds of arc.
(h) Record the number missed over the number possible. For example
“Titmus 0/9 PASS” or “1/9 FAIL”
k.
Field of Vision. Except for aviation personnel, special tests for field of
vision are not required unless medically indicated. Exact procedures on
how to perform this test can be obtained from the HS required references.
Chapter 3. C. Page 32
COMDTINST M6000.1E
l.
Night Vision. A test for night vision (dark adaptation) is not required
unless indicated for medical or special reasons.
m. Red Lens Test. The red lens test is required on DODMERB examinations
and when medically indicated. See manufactures instruction on how to
perform this test.
n.
Intraocular Tension.
(1) General. Determine intraocular tension each time an eye refraction is
performed, during all annual physical examinations, all aviation
physicals, and when medically indicated. Above normal tension is a
sign of glaucoma; below normal tension of ten exists in degenerated
eyeballs or as a normal finding; alterations in tension are sometimes
found in cyclitis. Questionable findings on palpation and
ophthalmoscopic examination shall be further evaluated.
(2) Testing Intraocular Tension.
(a) General. Routine tonometry shall be performed by a Medical
Officer, optometrist, or a technician who has received instruction
in properly performing and interpreting this test.
(b) Instrument. The tonometer estimates the intraocular pressure
(IOP) or tension within the eyeball.
(c) Precaution. Determine intraocular tension after all other eye
examinations have been completed. Because of corneal denuding
by tonometric measurement, a refraction (cycloplegic or manifest)
shall not be performed for at least 24 hours following this
procedure.
(d) Readings. Intraocular pressure consistently above 21mm Hg in
either eye or a difference of 4 or more between the two eyes, shall
be referred for ophthalmologic evaluation.
23. Audiometer.
a.
An audiometric examination is required on all physical examinations using
frequencies 500, 1000, 2000, 3000, 4000, and 6000 hertz.
b.
Obtain reference audiograms on all personnel upon initial entry into the CG
at recruit training and all officer accession points (Academy, OCS, Direct
Commission, etc.,), and at first duty station for all others.
24. Psychological and Psychomotor. Psychological and psychomotor testing is not
required unless medically indicated.
Chapter 3. C. Page 33
COMDTINST M6000.1E
FIGURE 3-C-2
The following chart enumerates certain conditions, defects, and items of personal history
that require thorough evaluation and sets forth the special test, examination, or report
desired in each instance.
ITEM:
DESIRED:
EXAMINATION
ALBUMINURIA, findings of
Repeat test on a second specimen. If still positive
do a quantitative 24 hr urine protein.
ASTHMA history of,
Detailed report of asthma and other allergic
conditions and a statement from cognizant
physician on (1) number and approximate dates of
attacks of asthmatic bronchitis or other allergic
manifestations; (2) signs, symptoms, and duration
of each attack; (3) type and amount of
bronchodilating drugs used, and history of any
attacks requiring hospitalization.
BACKACHE, back injury
Current orthopedic consultation and report on
or wearing of back strength,stability, mobility, and
functional brace, history of capacity of back.
Report of appropriate x-rays. Transcript of any
treatment from cognizant physician.
BLOOD PRESSURE, elevated
Repeat blood pressure (all positions) a.m. and p.m.
for 3 consecutive days. Prolonged bed rest shall not
precede blood pressure determinations.
CONCUSSIONS
See Head Injury
CONVULSIONS OR SEIZURE
Neurological consultation and
electroencephalogram. Transcript of any treatment
from cognizant physician.
DIABETES, family history
of parent, sibling, or more than
one grandparent
Fasting glucose (normal diet with 10-12 but less
than 16 hours fast). If elevated, repeat and include
2 hr post prandial.
DIZZINESS or FAINTING
SPELLS, history of
Neurological consultation
ENURESIS or history of
into late childhood or
adolescence (age 12)
Comment on applicant's affirmative reply
to question "bed wetting" to include number
of past incidents and age at last episode.
FLATFOOT, symptomatic
Current orthopedic consultation with history.
Detailed report on strength, stability, mobility, and
functional capacity of foot. Report of appropriate
x-rays.
GLYCOSURIA, finding or
History
See Diabetes.
Chapter 3. C. Page 34
AND
INFORMATION
COMDTINST M6000.1E
FIGURE 3-C-2 (cont.)
HAY FEVER, history of
Detailed report of hay fever and other allergic
conditions and a statement from personal physician
on (1) number, severity, and duration of attacks of
hay fever or any other allergic manifestations, and
(2) type and amount of drugs used in treatment
thereof.
HEADACHES, frequent or
severe, history of
Neurological consultation.
HEAD INJURY with loss of
consciousness in past 5
years, history of
Neurological consultation; clinical abstract
of treatment from physician.
HEMATURIA, history of or
finding of
Medical consultation with evaluation
report, including appropriate laboratory studies
and/or complete urological evaluation if indicated.
HEPATITIS, history of
Serum Bilirubin, SGOT, SGPT, SGT, AntiHCV,and HBsAg.
JAUNDICE, history of in
past 5 years
Serum Bilirubin, SGOT, SGPT, and SGT.
JOINT, KNEE, internal
derangement, history of
Current orthopedic consultation and
report of strength, stability, mobility, and functional
capacity of knee. Report of appropriate x-rays
together with comparative measurement of the
thighs, knees, and legs.
JOINT, SHOULDER,
dislocation, history of
Current orthopedic consultation and
report on strength, stability, mobility, and functional
capacity of shoulder. Report of appropriate x-rays.
MALOCCLUSION, TEETH,
history of
Report of examination by a dentist with comment
as to whether incisal and masticatory function is
sufficient for satisfactory ingestion of the ordinary
diet, statement as to presence and degree of facial
deformity with jaw in natural position and clarity of
speech.
MASTOIDECTOMY, bilateral,
history of audiogram.
Current ENT consultation to include
MOTION SICKNESS, history of
Detailed report of all occurrences of motion
sickness (such as air, train, sea, swing, carnivalride), and the age at the time of the last occurrence.
NASAL POLYPS, history of
ENT consultation, with comment as to date polyps
removed if no longer present. Detailed report by
physician on allergic history and manifestation to
include required medication.
SKULL FRACTURE, in past
5 years, history of
See Head Injury.
SLEEPWALKING, beyond
childhood, history of
(age 12)
Detailed comment by physician. Comment on
applicant's affirmative reply to question "been
a sleepwalker" to include number of incidents and
age at last episode.
Chapter 3. C. Page 35
COMDTINST M6000.1E
FIGURE 3-C-2 (cont.)
SQUINT (cross eyed)
Examination for degree of strabismus and
presence of complete and continuous 3rd degree
binocular fusion. Request completion of DD-2808
Items 62 and 65 and notation of degree of
strabismus.
STUTTERING or,
STAMMERING
Report of Reading Aloud Test in Section 3-C-2.
VERTEBRA, fracture or
dislocation, history of
Current orthopedic consultation and
report on strength, stability, mobility, and functional
capacity of spine. Report of appropriate x-rays.
Chapter 3. C. Page 36
COMDTINST M6000.1E
Figure 3-C-3
HEIGHT STANDARDS
Category
Minimum (cm/inches)
Maximum (cm/inches)
AVIATION PERSONNEL:
Candidate for Flight Training
157.4/62
198/78
Class 1 Pilot
157.4/62
198/78
Aircrew Candidate
152.5/60
198/78
Designated Aircrew
152.5/60
198/78
Enlistment in USCG
152.5/60
198/78*
Enlistment in USCG Reserve
152.5/60
198/78*
USCG Academy
152.5/60
198/78*
Officer Candidate School
152.5/60
198/78*
Appointment of Licensed
Officers of U.S. Merchant
Marines in the USCG
152.5/60
198/78*
Direct Commission in USCG
152.5/60
198/78*
ENLISTED PERSONNEL:
CANDIDATES FOR:
•
MAXIUM HEIGHTS WAIVERABLE TO 203 CM/ 80 INCHES BY
COMMANDER PERSONNEL SERVICE CENTER (PSC-adm-1)
NOTES:
1. Heights are without shoes.
2. Metric conversion: 1 inch = 2.54 cm
Chapter 3. C. Page 37
COMDTINST M6000.1E
Figure 3-C-4
MINIMUM DISTANT VISUAL ACUITY REQUIREMENTS
CATEGORY
VISION
A. Aviation Personnel:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Uncorrected
Candidates for Flight Training
Pilot, Class
Pilot, Class 1R
Flight Surgeon,
Aviation Medical Examiner or
Aviation Mission Specialist
Candidate for Aircrew
Designated Aircrew
Landing Signal Officer (LSO)
Air Traffic Controller Candidate
Designated Air Traffic Controller
20/50
20/200
(as waivered)
Corrected
20/20
20/20
20/20
20/400
20/100
20/200
20/200
20/100
20/200
20/20
20/20
20/20
20/20
20/20
20/20
20/400
20/20
20/400
20/20
20/400
20/400
20/400
20/400
20/400
20/20
20/20
20/20
20/20
20/20
20/100
20/200
20/20
20/20
See 3.D.9
(Note 3)
(Note 3)
(Note 2)
20/20
20/20
B. Officers (Note 1):
1. Commissioned or Warrant in the
USCG or USCGR
2. Appt in the USCG of Licensed
Officers of the Merchant Marine
3. Direct Commission in the USCGR
4. Appointment as Cadet
5. Precommissioning of Cadets
6. OCS Candidates
7. Precommissioning of Officer
Candidates
8. Diving Candidates
9. Designated Diver
C. Enlisted Personnel:
1. Enlistment in the USCG or USCGR
2. Diving Candidates
3. Designated Diver
Notes:
1. Refractive error does not exceed plus or minus 8.0 diopters spherical equivalent
(sphere + 1/2 cylinder) and that astigmatism does not exceed 3.00 diopters and
anisometropia does not exceed 3.50 diopters.
2. Corrected vision shall be 20/40 in the better eye and 20/70 in the other or 20/30 in the
better eye and 20/100 in the other, or 20/20 in the better and 20/400 in the other.
(Note that near visual acuity must correct to at least 20/40 in the better eye.)
Refractive error does not exceed plus or minus 8.00 diopters spherical equivalent
(sphere + 1/2 cylinder) and ordinary spectacles do not cause discomfort by reason of
ghost images, prismatic displacement, etc.; error must not have been corrected by
orthokeratology or keratorefractive surgery.
3. 20/100 in the better eye and 20/200 in the worse eye.
Chapter 3. C. Page 38
COMDTINST M6000.1E
Section D. Medical Standards for Appointment, Enlistment and Induction in the Armed
Forces
1.
Scope ........................................................................................................................1
2.
Medical Standards....................................................................................................1
3.
Policy .......................................................................................................................2
4.
Responsibilities of Commandant (CG-11)...............................................................2
5.
Height.......................................................................................................................3
6.
Weight ......................................................................................................................3
7.
Head .........................................................................................................................3
8.
Eyes ..........................................................................................................................3
9.
Vision .......................................................................................................................7
10. Ears ..........................................................................................................................8
11. Hearing.....................................................................................................................8
12. Nose, Sinuses, Mouth and Larynx ...........................................................................9
13. Dental .....................................................................................................................10
14. Neck .......................................................................................................................11
15. Lungs, Chest Wall, Pleura, and Mediastinum........................................................11
16. Heart.......................................................................................................................13
17. Abdominal Organs and Gastrointestinal System ...................................................16
18. Female Genitalia ....................................................................................................19
19. Male Genitalia........................................................................................................20
20. Urinary System .....................................................................................................21
21. Spine and Sacroiliac Joints ....................................................................................22
22. Upper Extremities .................................................................................................23
23. Lower Extremities..................................................................................................25
24. Miscellaneous Conditions of the Extremities ........................................................27
25. Vascular System.....................................................................................................28
26. Skin and Cellular Tissues.......................................................................................29
27. Blood and Blood-Forming Tissues ........................................................................31
28. Systemic .................................................................................................................31
29. Endocrine and Metabolic .......................................................................................34
30. Neurologic..............................................................................................................35
31. Learning, Psychiatric, and Behavioral ...................................................................37
32. Tumors and Malignancies. .....................................................................................40
33. Miscellaneous ........................................................................................................40
Figure 3-D-1 Evaluation for Risk of Head Injury Sequelae ...........................................42
Figure 3-D-2 Classification & Comparative Nomenclature of Cervical Smears ...........43
Chapter 3. D. Page i
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Chapter 3. D. Page ii
COMDTINST M6000.1E
D. Medical Standards for Appointment, Enlistment and Induction in the Armed
Forces.
1. Scope. This section applies to the Office of the Secretary of Defense, the
Military Departments (including the CG at all times, including when it is a service
in the Department of Homeland Security by agreement with that Department), the
United States Merchant Marine Academy by agreement with the Secretary of
Commerce, the Office of the Chairman of the Joint Chiefs of Staff and the Joint
Staff, the Combatant Commands, the Office of the Inspector General of the
Department of Defense, the Defense Agencies, the DoD Field Activities, and all
other organizational entities in the DoD (hereinafter referred to collectively as the
“DOD Components”). The term “Armed Forces,” as used herein, refers to the
Army, Navy, Air Force, Marine Corps, and the CG.
2. Medical Standards. This section establishes medical standards, which if not met,
are grounds for rejection for military service. Other standards may be prescribed
for a mobilization for a national emergency. The medical standards in this section
apply to the following personnel:
a. Applicants for appointment as commissioned or warrant officers in the active
and reserve components.
b. Applicants for enlistment in the Armed Forces. For medical conditions or
defects predating original enlistment, these standards apply to enlistees’ first
six (6) months of active duty.
c. During training. Applicants for enlistment in the Reserve and federally
recognized units or organizations of the National Guard. For medical
conditions or defects predating original enlistment, these standards apply
during the enlistees’ initial period of active duty for training until their return
to Reserve or National Guard units.
d. After 12 months. Applicants for reenlistment in Regular and Reserve
components and in federally recognized units or organizations of the National
Guard when after a period of more than twelve (12) months have elapsed
since discharge.
e. Schools. Applicants for the Scholarship or Advanced Course Reserve
Officers Training Corps (ROTC), and all other Armed Forces’ special officer
personnel procurement programs.
f. Retention of cadets and midshipmen at the U.S. Service Academies and
students enrolled in ROTC scholarship programs.
g. Individuals on the Temporary Disability Retired List (TDRL). Individuals on
the TDRL who have been found fit on reevaluation and wish to return to
active duty. The prior disabling condition(s) and any other medical conditions
Chapter 3. D. Page 1
COMDTINST M6000.1E
identified before placement on the TDRL, that shall not have prevented
reenlistment, are exempt from this Instruction.
h. All individuals being inducted into the Armed Forces.
3. Policy.
a. International Classification of Disease (ICD) codes. It is CG policy, by
agreement with DoD Directive 6130 (series) Physical Standard for
Appointment, to utilize the ICD codes in this Section, in all records pertaining
to a medical condition that results in a personnel action, such as separation or
medical waiver. In addition, when a medical condition standard is waived or
results in a separation, written clarification of the personnel action should be
provided using standard medical terminology.
b. Standards. The standards in this section shall be for the acquisition of
personnel in the programs in 3.D.2 of this Manual.
c. Disqualifying standards. Unless otherwise stipulated, the conditions listed in
this section are those that would be disqualifying by virtue of current
diagnosis, or for which the candidate has a verified past medical history. The
medical standards for appointment, enlistment or induction into the Armed
Forces are classified by the following general systems.
4.
Responsibilities of Commandant (CG-11).
a. Review CG policies. Review CG policies to conform with the standards
contained in DoD Directive 6130 (series) Physical Standard for appointment.
b. Recommend changes. Recommend to the Office of the Assistant Secretary of
Defense (Health Affairs) [OASD (HA)] suggested changes in the standards
after service coordination has been accomplished.
c. Review all the standards on a quinquennial basis. Review all the standards on
a quinquennial basis and recommend changes to the OASD (HA). This
review will be initiated and coordinated by the DoD Medical Examination
Review Board.
d. Implement standards. Ensure that implementation of the standards in this
section are accomplished throughout the U.S. Military Entrance Processing
Command.
e. Direct clinics. Under the provisions of DoD Directive 6130 (series), Medical
Standards for Appointment, Enlisted or Induction, direct the clinics to apply
and uniformly implement the standards contained in this section.
f. Authorize waivers. Commandant (CG-11) delegates to CG PSC and the CG
Recruiting Command the authority to implement waiver procedures that
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COMDTINST M6000.1E
ensures the uniform application of appointment, enlistment, induction and
retention standards.
g. Authorize changes in visual standards. Authorize the changes in Servicespecific visual standards (particularly for officer accession programs) and
establish other standards for special programs. Notification of any proposed
changes in standards shall be provided to the ASD (HA) at least 60 days
before implementation.
h. Ensure that accurate ICD codes are assigned. Ensure that accurate ICD codes
are assigned to all medical conditions resulting in a personnel action, such as
separation, waiver, or assignment limitation, and that such codes are included
in all records of such actions.
i. Eliminate inconsistencies and inequities based on race, sex, or examination
location in the application of these standards by the Armed Forces.
5. Height. The causes for rejection for appointment, enlistment, and induction in
relation to height standards are established by each of the military services.
Height standards for the CG are:
a. Men: Height below 152.5 cm (60 inches) or over 198 cm (78 inches).
b. Women: Height below 152.5 cm (60 inches) or over 198 cm (78 inches).
6. Weight. The causes for rejection for appointment, enlistment, and induction in
relation to weight standards are contained in Weight /Physical Fitness Standards
for CG Military Personnel, COMDTINST M1020.8 (series).
7. Head.
a. Deformities. Deformities of the skull, face, or mandible (754.0) of a degree
that shall prevent the individual from the proper wearing of a protective mask
or military headgear are disqualifying.
b. Bone loss. Loss, or absence of the bony substance of the skull (756.0 or
738.1) not successfully corrected by reconstructive materials, or leaving
residual defect in excess of one (1) square inch (6.45cm2), or the size of a 25cent piece is disqualifying.
8. Eyes.
a. Lids.
(1) Current Blepharitis (373.0), chronic or acute, until cured (373.00) is
disqualifying.
(2) Current Blepharospasm (333.81) is disqualifying.
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COMDTINST M6000.1E
(3) Current Dacryocystitis, acute (375.32), chronic (375.42), or unspecified
(375.30) is disqualifying.
(4) Deformity of the lids or other disorders affecting eyelid function (374.4),
complete or extensive lid deformity, or significant ptosis, sufficient to
interfere with vision or impair protection of the eye from exposure is
disqualifying.
(5) Current growths or tumors of the eyelid, other than small, nonprogressive, asymptomatic, benign lesions, are disqualifying.
b. Conjunctiva.
(1) Current chronic conjunctivitis (372.1), including but not limited to
trachoma (076) and chronic allergic conjunctivitis (372.14), is
disqualifying.
(2) Current or recurrent Pterygium (372.4) if condition encroaches on the
cornea in excess of three (3) millimeters, interferes with vision, is a
progressive peripheral Pterygium (372.42), or is a recurring Pterygium
after two (2) operative procedures (372.45) is disqualifying.
(3) Current Xerophthalmia (372.53) or other manifestations of Vitamin A
deficiency xerophthalmia (264.7) is disqualifying.
c. Cornea.
(1) Current or history of corneal dystrophy or degeneration of any type
(371.5), including but not limited to keratoconus (371.6) of any degree, is
disqualifying.
(2) History of refractive surgery, including but not limited to: Lamellar
(P11.7) and/or penetrating keratoplasty (P11.6), Radial Keratotomy, and
Astigmatic Keratotomy is disqualifying. Refractive surgery performed
with an Excimer Laser, including but not limited to, Photorefractive
Keratectomy (commonly known as PRK), Laser Epithelial Keratomileusis
(commonly known as LASEK), and laser-assisted in situ Keratomileusis
(commonly known as LASIK) (ICD-9 code for each is P11.7) is
disqualifying if any of the following conditions are met:
(a) Pre-surgical refractive error in either eye exceeded a spherical
equivalent of +8.00 to-8.00 diopters.
(b) For initial LASIK, at least 90 days recovery period has not occurred
between last refractive surgery or augmenting procedure and accession
medical examination. For all other laser refractive corneal surgery, at
least 180 days recovery period has not occurred between last refractive
or augmenting procedure and accession medical examination.
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COMDTINST M6000.1E
(c) There have been complications and/or medications or ophthalmic
solutions, or any other therapeutic interventions such as sunglasses, are
required.
(d) Post-surgical refraction in each eye is not stable as demonstrated by at
least two (2) separate refractions at least one (1) month apart, with one
refraction at least 90 days post-procedure, and the most recent of
which demonstrates more than +/- 0.50 diopters difference for
spherical vision and/or more than +/- 0.50 diopters for cylinder vision.
(3) Current keratitis (370), acute or chronic, including but not limited to
recurrent corneal ulcers (370.0), erosions (abrasions), or herpetic ulcers
(054.42) is disqualifying.
(4) Current corneal neovascularization, unspecified (370.60), or corneal
opacification (371) from any cause that is progressive or reduces vision
below the prescribed visual acuity standards is disqualifying.
(5) Current or history of Uveitis or Iridocyclitis (364.3) is disqualifying.
(6) Implantable Contact Lenses (ICL) may be considered for an accession
waiver into the CG as long as the following conditions are met: (This does
not apply to aviation personnel)
(a) Accession vision standards are met.
(b) Six (6) months has elapsed since the procedure was performed.
d.
Retina.
(1) Current or history of retinal conditions that impair visual function or
are progressive, including retinal defects and dystrophies,
Angiomatoses (759.6), retinoschisis and retinal cysts (361.1),
phakomas (362.89), and other congenito-retinal hereditary conditions
(362.7).
(2) Current or history of any chorioretinal or retinal inflammatory
conditions, including but not limited to conditions leading to
neovascularization, chorioretinitis, histoplasmosis, toxoplasmosis, or
vascular conditions of the eye, to include Coat’s Disease or Eales
Disease.
(3) Current or history of degenerative changes of any part of the retina
(362.60) is disqualifying.
(4) Current or history of detachment of the retina (361), history of surgery
for same, or peripheral retinal injury, defect (361.3), or degeneration that
may cause retinal detachment is disqualifying.
e.
Optic Nerve.
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COMDTINST M6000.1E
(1) Current or history of optic neuritis (377.3), including but not limited to
Neuroretinitis, secondary optic atrophy, or documented history of
retrobulbar neuritis is disqualifying.
(2) Current or history of optic atrophy (377.1) or cortical blindness
(377.75) is disqualifying.
(3) Current or history of Papilledema (377.0) is disqualifying.
f.
Lens.
(1) Current Aphakia (379.31), history of lens implant, or
current or history of dislocation of a lens is disqualifying.
(2) Current or history of opacities of the lens (366), including
cataract (366.9), are disqualifying.
g.
Ocular Mobility and Motility.
(1) Current or recurrent Diplopia (368.2) is disqualifying.
(2) Current nystagmus (379.50) other than physiologic "endpoint nystagmus" is disqualifying.
(3) Esotropia (378.0), exotropia (378.10), and hypertropia
(378.31): For entrance into Service academies and officer
programs, the individual Military Services may set
additional requirements. The Military Services shall
determine special administrative criteria for assignment to
certain specialties.
h.
Miscellaneous Defects and Diseases.
(1) Current or history of abnormal visual fields due to diseases of
the eye or central nervous system (368.4), or trauma (368.9) is
disqualifying.
(2) Absence of an eye, clinical anophthalmos, unspecified
congenital (743.00) or acquired, current, or history of other
disorders of globe (360.8) is disqualifying.
(3) Current asthenopia (368.13) is disqualifying.
(4) Current unilateral or bilateral non-familial exophthalmoses
(376) are disqualifying.
(5) Current or history of glaucoma (365), including but not
limited to pre-glaucoma (365.0 -365.04) as evidenced by
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COMDTINST M6000.1E
intraocular pressure above 21 millimeters of mercury (mmHg)
on two (2) or more determinations using applanation tonometry,
or changes in the optic disc, or visual field loss associated with
glaucoma is disqualifying.
(6) Current loss of normal pupillary reflex, reactions to
accommodation (367.5) or light (379.4), including Adie's
Syndrome is disqualifying.
(7) Current night blindness (368.60) is disqualifying.
(8) Current or history of intraocular foreign body (360) is
disqualifying.
(9) Current or history of ocular tumors (190) is disqualifying.
(10) Current or history of any organic disease of the eye (360) or
adnexa (376, 379.9), not specified in paragraph E1.2.1. through
subparagraph E1.2.9.8. above, which threatens vision or visual
function is disqualifying.
9. Vision. The Secretaries of the Military Departments shall, under the provisions of
DoD Directive 6130 (series), Medical Standards for Appointment, Enlistment, or
Induction in the Armed Forces have authority to change Service-specific vision
standards and establish other standards for special programs.
a. Distant visual acuity. Current distant visual acuity of any degree that does not
correct to at least one of the following (367) is disqualifying.
(1) 20/40 in one eye and 20/70 in the other eye.
(2) 20/30 in one eye and 20/ 100 in the other eye.
(3) 20/20 in one eye and 20/400 in the other eye.
b. Near visual acuity. Current near visual acuity of any degree that does not
correct to 20/40 in the better eye (367) is disqualifying.
c. Refractive error. Current refractive error [hyperopia (367.0), myopia (367.1),
astigmatism (367.2)] or history of refractive error prior to any refractive
surgery manifest by any refractive error in spherical equivalent of worse than 8.00 or +8.00 diopters is disqualifying. Waivers may be considered on a case by
case basis for non-aviation new accessions who have up to -10.00 diopters of
myopia if the following conditions are met: a) the potential accession has had a
retinal evaluation performed by an ophthalmologist in the twelve months prior to
requesting the waiver; b) the retinal evaluation yields normal results and there is
no evidence of ocular pathology including but not limited to retinal detachments,
retinal tears or lattice degeneration and; c) there is no history of prior ocular
pathology or retinal surgery. This waiver consideration should also be applied to
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COMDTINST M6000.1E
potential accessions who otherwise meet accession post-refractive surgery criteria
as outlined in chapter 3-D.8.c(2) of ref (a).
d. Cases requiring contact lenses. Current complicated cases requiring contact
lenses for adequate correction of vision, such as corneal scars and opacities
(370.00) and irregular astigmatism (367.22) are disqualifying.
e. Color vision (368.5). Failure to pass a color vision test is not an automatic
disqualification. For entrance into U.S. Service Academies, ROTC, and special
programs, color vision requirements may be set by the individual Services.
10. Ears.
a. External ear. Current atresia of the external ear (744.02) or severe microtia
(744.23), congenital or acquired stenosis (380.5), chronic otitis externa
(380.2), or severe external ear deformity (744.3) that prevents or interferes
with the proper wearing of hearing protection is disqualifying.
b. Mastoiditis. Current or history of mastoiditis (383.9), residual with fistula
(383.81), chronic drainage or conditions requiring frequent cleaning of the
mastoid bone is disqualifying.
c. Ménière's Syndrome. Current or history of Ménière's Syndrome or other
chronic diseases of the vestibular system (386) are disqualifying.
d. Inner ear. Current or history of chronic otitis media (382) beyond the
thirteenth (13th) birthday, cholesteatoma (385.3), or history of any inner
(P20) or middle (P 19) ear surgery (including cochlear implantation) is
disqualifying. Myringotomy or successful tympanoplasty is NOT
disqualifying.
e. Perforation of the tympanic membrane. Current perforation of the tympanic
membrane (384.2) or history of surgery to correct perforation during the
preceding 120 days (P 19) is disqualifying.
11. Hearing. All hearing defects are coded with ICD-9 code 389.
a. Audiometric Hearing Levels.
(1) Audiometric hearing levels are measured by audiometers calibrated
to the standards in American National Standards Institute (ANSI
S3.6-2004) and shall be used to test the hearing of all applicants.
(2) Current hearing threshold level in either ear greater than that
described below is disqualifying:
(a) Pure tone at 500, 1000, and 2000 cycles per second for each ear
of not more than 30 decibels (dB) on the average with no
individual level greater than 35 dB at those frequencies.
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COMDTINST M6000.1E
(b) Pure tone level not more than 45 dB at 3000 cycles per second
or 55 dB at 4000 cycles per second for each ear.
(c) There is no standard for 6000 cycles per second.
b. Current or history of hearing aid use (V53.2) is disqualifying.
12. Nose, Sinuses, Mouth and Larynx.
a. Rhinitis.
(1) Current allergic rhinitis due to pollen (477.0), other allergen
(477.8), or cause unspecified (477.9), if not controlled by oral
medication or topical corticosteroid medication is disqualifying.
History of allergic rhinitis immunotherapy within the previous
year is disqualifying.
(2) Current chronic non-allergic rhinitis (472.0) if not controlled by
oral medication or topical corticosteroid medication is
disqualifying.
b. Cleft lip or palate. Current cleft lip or palate defects (749) not
satisfactorily repaired by surgery or that interferes with the use of
wear of military equipment, or that prevents drinking from a straw is
disqualifying.
c. Leukoplakia. Current leukoplakia of oral mucosa, including tongue
(528.6) is disqualifying.
d. Chronic conditions of larynx. Current chronic conditions of larynx
including vocal cord paralysis (478.3), chronic hoarseness (784.49),
chronic laryngitis (476.0), larynx ulceration (478.79), polyps (478.4),
granulation tissue (478.5), or other symptomatic disease of larynx or
vocal cord dysfunction not elsewhere classified (478.7) are
disqualifying.
e. Anosmia or parosmia. Current anosmia or parosmia (781.1) is
disqualifying.
f. Epistaxis. History of recurrent epistaxis with more than one episode
per week of bright red blood from the nose occurring over a three (3)
month period (784.7) is disqualifying.
g. Nasal polyp or history of nasal polyps. Current nasal polyp or history
of nasal polyps (471), unless more than twelve (12) months have
elapsed since nasal polypectomy and asymptomatic is disqualifying.
Chapter 3. D. Page 9
COMDTINST M6000.1E
h. Perforation of nasal septum. Current perforation of nasal septum
(478.1) is disqualifying.
i. Chronic sinusitis. Current chronic sinusitis (473) or current acute
sinusitis (461.9) is disqualifying. Such conditions exist when
evidenced by chronic purulent discharge, hyperplastic changes of
nasal tissue, symptoms requiring frequent medical attention, or X-ray
findings.
j. Trachea. Current or history of tracheostomy (V44.0) or tracheal fistula
(530.84) is disqualifying.
k. Anomalies of upper alimentary tract. Current or history of deformities,
or conditions or anomalies of upper alimentary tract (750.9), of the
mouth, tongue, palate, throat, pharynx, larynx, and nose that interfere
with chewing, swallowing, speech, or breathing is disqualifying.
l. Pharyngitis. Current chronic pharyngitis (472.1) and chronic
nasopharyngitis (472.2) are disqualifying.
13. Dental.
a. Diseases of the jaw. Current diseases or pathology of the jaws or
associated tissues that prevent normal functioning are disqualifying.
Those diseases or conditions include but are not limited to
temporomandibular disorders (524.6) and/or myofascial pain. A
minimum of six (6) months healing time must elapse for any
individual completing surgical treatment of any maxillofacial
pathology lesions.
b. Severe malocclusion. Current severe malocclusion (524), which
interferes with normal mastication or requires early and protracted
treatment, or a relationship between the mandible and maxilla that
prevents satisfactory future prosthodontic replacement is
disqualifying.
c. Insufficient natural healthy teeth. Current insufficient natural healthy
teeth, six (6) or more grossly (visually) cavitated and/or carious teeth
(521.0) is disqualifying. Lack of a serviceable prosthesis that
prevents adequate incision and mastication of a normal diet is
disqualifying. Applicants with multiple complex dental fixtures
and/or implant plant systems with associated complications are
disqualifying. Individuals undergoing endodontic care are acceptable
for entry in the Delayed Entry Program (DEP) only if a civilian or
military dentist or endodontist provides documentation that active
endodontic treatment shall be completed prior to being sworn into
active duty.
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COMDTINST M6000.1E
d. Current orthodontic appliances. Current orthodontic appliances for
continued treatment (V53.4) are disqualifying. Permanent or
removable retainer appliances are permissible, provided all active
orthodontic treatment has been satisfactorily completed. Individuals
undergoing active orthodontic care are acceptable for accession
(including DEP) only if a civilian or military orthodontist provides
documentation that active orthodontic treatment shall be completed
prior to being sworn into active duty. Entrance into active duty will
not occur until all orthodontic treatment is documented to be
completed.
14. Neck.
a. Current symptomatic cervical ribs (756.2) are disqualifying.
b. History of congenital cyst(s). Current or history of congenital cyst(s) (744.4)
of branchial cleft origin or those developing from the remnants of the
thyroglossal duct, with or without fistulous tracts, is disqualifying.
c. Contraction of the neck muscles. Current contraction (723) of the muscles of
the neck, spastic or non-spastic, or cicatricial contracture of the neck to the
extent it interferes with the proper wearing of a uniform or military equipment,
or is so disfiguring as to interfere with or prevent satisfactory performance of
military duty is disqualifying.
15. Lungs, Chest Wall, Pleura, and Mediastinum.
a. Elevation of the diaphragm. Current abnormal elevation of the diaphragm
(either side) is disqualifying. Any nonspecific abnormal findings on
radiological and other examination of body structure, such as lung field
(793.1) or other thoracic or abdominal organ (793.2) is disqualifying.
b. Current abscess of the lung or mediastinum (513) are disqualifying.
c. Acute infection of the lungs. Current or history of recurrent acute infectious
processes of the lung, including but not limited to viral pneumonia (480),
pneumococcal pneumonia (481), bacterial pneumonia (482), pneumonia due to
other specified organism (483), pneumonia infectious disease classified
elsewhere (484), bronchopneumonia (organism unspecified) (485), pneumonia
(organism unspecified) (486), are disqualifying.
d. Asthma. Airway hyper responsiveness including asthma (493), reactive airway
disease, exercise-induced bronchospasm or asthmatic bronchitis, reliably
diagnosed and symptomatic after the 13th birthday is disqualifying.
(1) Reliable diagnostic criteria may include any of the following elements:
Substantiated history of cough, wheeze, chest tightness and/or dyspnea
Chapter 3. D. Page 11
COMDTINST M6000.1E
which persists or recurs over a prolonged period of time, generally more
than twelve (12) months.
(2) Individuals meet the standard if within the past three (3) years there is or
are:
(a) No use of controller or rescue medications, including but not limited
to inhaled corticosteroids, leukotriene receptor antagonists, or short-acting
beta agonists.
(b) No exacerbations requiring acute medical treatment.
(c) No use of oral steroids, and a current normal spirometry (within the
past ninety (90) days) performed in accordance with American Thoracic
Society (ATS) guidelines and as defined by current National Heart, Lung,
and Blood Institute (NHLBI) standards.
e. Current bronchitis (490), acute or chronic symptoms over three (3) months
occurring at least twice a year (491) is disqualifying.
f. Current or history of bronchiectasis (494) is disqualifying. Bronchiectasis
during the first year of life is not disqualifying if there are no residual or
sequelae.
g. Current or history of bronchopleural fistula (510), unless resolved with no
sequelae is disqualifying.
h. Current or history of Chronic Obstructive Pulmonary Disease (491), or
bullous or generalized pulmonary emphysema (492) is disqualifying.
i. Current chest wall malformation (754.89), including but not limited to pectus
excavatum (754.81) or pectus carinatum (754.82), if these conditions interfere
with vigorous physical exertion is disqualifying.
j. History of emphysema (510.9) is disqualifying.
k. Pulmonary fibrosis (515) is disqualifying.
l. Current foreign body in lung (934.8, 934.9), trachea (934.0), or bronchus
(934.1) is disqualifying.
m. History of thoracic surgery (P 32-33), including open and endoscopic
procedures is disqualifying.
n. Current or history of pleurisy with effusion (511.9) within the previous two (2)
years is disqualifying.
Chapter 3. D. Page 12
COMDTINST M6000.1E
o. Current or history of pneumothorax (512) occurring during the year preceding
examination if due to trauma (860) or surgery, or occurring during the two (2)
years preceding examination from spontaneous (512.8) origin is disqualifying.
p. Recurrent spontaneous pneumothorax (512.8) is disqualifying.
q. History of chest wall surgery (34-34.9), including breast (85-85.9), during the
preceding six (6) months, or with persistent functional limitations is
disqualifying.
16. Heart.
a. Valvular heart diseases. History of valvular repair or replacement
is disqualifying.
(1) Current or history of the following valvular conditions as
defined by the current American College of Cardiology and
American Heart Association guidelines does not meet the
standard:
(a) Severe pulmonic regurgitation.
(b) Severe tricuspid regurgitation.
(c) Moderate pulmonic regurgitation unless documented mean
pulmonary artery pressure <25mm Hg.
(d) Moderate tricuspid regurgitation unless documented mean
pulmonary artery pressure <25mm Hg.
(e) Moderate or severe mitral regurgitation.
(f) Mild, moderate or severe aortic regurgitation.
(2) The following are considered normal variants that meet the
standards:
(a) Trace or mild pulmonic regurgitation.
(b) Trace or mild tricuspid regurgitation.
(c) Trace or mild mitral regurgitation in the absence of mitral valve
prolapse.
(d) Trace Aortic insufficiency.
b. Mitral valve prolapse with normal exercise tolerance not requiring
medical therapy meets the standard.
Chapter 3. D. Page 13
COMDTINST M6000.1E
c. Bicuspid aortic valve (746.4), in the absence of stenosis or
regurgitation as in 16.a.(1) above, meets the standard.
d. All valvular stenosis.
e. Current or history of atherosclerotic coronary heart disease (410).
f. Current history of pacemaker or defibrillator implantation.
g. History of supraventricular tachycardia.
(1) Supraventricular tachycardia (427.0) associated with an
identifiable reversible cause and no recurrence during the
preceding two (2) years while off all medications meets the
standard.
(2) Those with identified atrioventricular nodal reentrant
tachycardia (AVNRT) or atrioventricular reentrant tachycardia
(AVRT) Wolff-Parkinson-White syndrome (WPW) who have
undergone successful ablative therapy with no recurrence of
symptoms after three (3) months and with documentation of
normal electrocardiograph (ECG) meet the standard.
(3) History of recurrent atrial fibrillation or flutter.
h. Premature atrial or ventricular contractions sufficiently
symptomatic to require treatment, or result in physical or
physiological impairment.
i. Abnormal ECG patterns:
(1) Long QT.
(2) Brugada pattern.
(3) WPW pattern does not meet the standard unless associated
with low risk accessory pathway by appropriate diagnostic testing.
j. Current or history of ventricular arrhythmias (427.1) including
ventricular fibrillation, tachycardia, or multifocal premature
ventricular contractions. Occasional asymptomatic unifocal
premature ventricular contractions meet the standard.
k. Current or history of conduction disorders, including but not
limited to disorders of sinus arrest, asystole, Mobitz type II
second-degree atrioventricular (AV) block (426.12), and thirddegree AV block (426.0).
Chapter 3. D. Page 14
COMDTINST M6000.1E
l. In the absence of cardiovascular symptoms the following meet the
standard:
(1) Sinus arrhythmia.
(2) First degree AV block.
(3) Left axis deviation of < -45 degrees.
(4) Early repolarization.
(5) Incomplete right bundle branch block.
(6) Wandering atrial pacemaker or ectopic atrial rhythm.
(7) Sinus bradycardia.
(8) Mobitz type I second-degree AV block (426.13)
m. Current or history of conduction disturbances such as left anterior
hemiblock (426.2), right or left bundle branch block (426.4) do
not meet the standard unless asymptomatic with a normal
echocardiogram.
n. Current or history of cardiomyopathy (425), cardiomegaly,
hypertrophy (defined as septal wall thickness of 15mm or greater),
dilation (429.3) or congestive heart failure (428).
o. History of myocarditis (422) or pericarditis (420) does not meet
the standard unless the individual is free of all cardiac symptoms,
does not require medical therapy, and has normal
echocardiography for at least one year.
p. Current persistent tachycardia (785.0) (as evidenced by average
heart rate of 100 beats per minute or greater over a 24 hour period
of continuous monitoring).
q. Current or history of congenital anomalies of heart and great
vessels (746). The following conditions meet the standard with an
otherwise normal current (within 6 months) echocardiogram.
(1) Dextrocardia with Situs inversus without any other anomalies.
(2) Ligated or occluded patent ductus arteriosus.
(3) Corrected atrial septal defect/patent foramen ovale without
residual.
Chapter 3. D. Page 15
COMDTINST M6000.1E
(4) Corrected ventricular septal defect without residual.
r. History of recurrent syncope and/or presyncope (780.2), to
include black out, fainting, loss of alteration of level of
consciousness (excludes vasovagal reactions with identified
trigger such as venipuncture) does not meet standard unless there
has been no recurrence during the preceding two (2) years while
off all medications.
17. Abdominal Organs and Gastrointestinal System.
a. Esophageal Disease.
(1) Current or history of esophageal disease (530.0-530.9), including but not
limited to ulceration, varices, fistula, achalasia is disqualifying.
(2) Gastro-Esophageal Reflux Disease (GERD) (530.81), with complications
including stricture, or maintenance on acid suppression medication, other
dysmotility disorders; or chronic or recurrent esophagitis (530.1), is
disqualifying.
(3) Current or history of reactive airway disease associated with GERD
(530.81) is disqualifying.
(4) History of surgical correction for GERD within six (6) months (P42
esophageal correction, P43 stomach correction, and P45 intestinal
correction.) is disqualifying.
(5) Current or history of dysmotility disorders and chronic or recurrent
esophagitis (530) is disqualifying.
(Waivers will not be granted for surgeries performed to control weight including
all forms of bariatric surgery)
b. Stomach and Duodenum.
(1) Current gastritis, chronic or severe (535), or non-ulcerative
dyspepsia that requires maintenance medication is
disqualifying.
(2) Current or history of ulcer of stomach or duodenum
confirmed by X-ray or endoscopy (533) is disqualifying.
(3) History of surgery for peptic ulceration or perforation
(533.0-599.9) is disqualifying.
Chapter 3. D. Page 16
COMDTINST M6000.1E
c. Small and Large Intestine.
(1) Current or history of inflammatory bowel disease, including but not limited
to unspecified (558.9), regional enteritis or Crohn's disease (555),
ulcerative colitis (556), or ulcerative proctitis (556.2), is disqualifying.
(2) Current or history of intestinal malabsorption syndromes, including but not
limited to post-surgical and idiopathic (579), is disqualifying. Lactase
deficiency is disqualifying only if of sufficient severity to require frequent
intervention, or to interfere with normal function.
(3) Current or history of gastrointestinal functional and motility disorders
within the past two (2) years, including but not limited to pseudoobstruction, megacolon, history of volvulus, or chronic constipation and/or
diarrhea (787.91), regardless of cause, persisting or symptomatic in the past
two (2) years, is disqualifying.
(4) History of gastrointestinal bleeding (578), including positive occult blood
(792.1), if the cause has not been corrected is disqualifying. Meckel's
diverticulum (751.0), if surgically corrected greater than six (6) months
prior is not disqualifying.
(5) Current or history of irritable bowel syndrome (564.1) of sufficient severity
to require frequent intervention or to interfere with normal function is
disqualifying.
(6) History of bowel resection is disqualifying.
(7) Current or history of symptomatic diverticular disease of the intestine (562)
is disqualifying.
d. Hepatic-Biliary Tract.
(1) Current acute or chronic hepatitis, hepatitis carrier state (070), hepatitis in
the preceding six (6) months or persistence of symptoms after six (6)
months, or objective evidence of impairment of liver function is
disqualifying.
(2) Current or history of cirrhosis (571), hepatic cysts (573.8), abscess
(572.0), or sequelae of chronic liver disease (571.3) is disqualifying.
(3) Current or history of symptomatic cholecystitis, unless successfully
surgically corrected, acute or chronic, with or without cholelithiasis (574);
postcholecystectomy syndrome; or other disorders of the gallbladder and
biliary system (576) is disqualifying. Cholecystectomy is not
disqualifying if performed greater than six (6) months prior to examination
and patient remains asymptomatic. Fiberoptic procedure to correct
sphincter dysfunction or cholelithiasis, if performed greater than six (6)
Chapter 3. D. Page 17
COMDTINST M6000.1E
months prior to examination and patient remains asymptomatic may not be
disqualifying.
(4) Current or history of pancreatitis, acute (577.0) or chronic (577.1) is
disqualifying.
(5) Current or history of metabolic liver disease, including but not limited to
hemochromatosis (275.0), Wilson's disease (275.1), or alpha-1 anti-trypsin
deficiency (273.4) is disqualifying.
(6) Current enlargement of the liver from any cause (789.1) is disqualifying.
e. Anorectal.
(1) Current anal fissure or anal fistula (565) is disqualifying.
(2) Current or history of anal or rectal polyp (569.0), prolapse (569.1),
stricture (569.2), or fecal incontinence (787.6) within the last two (2) years
is disqualifying.
(3) Current hemorrhoid (internal or external), when large, symptomatic, or
with a history of bleeding (455) within the last sixty (60) days, is
disqualifying.
f. Spleen.
(1) Current splenomegaly (789.2) is disqualifying.
(2) History of splenectomy (P41.5) is disqualifying, except when resulting
from trauma.
g. Abdominal Wall.
(1) Current hernia (except for small or asymptomatic umbilical hernias),
including but not limited to uncorrected inguinal (550) and other abdominal
wall hernias (553) are disqualifying.
(2) History of open or laparoscopic abdominal surgery (P54) during the
preceding six (6) months is disqualifying.
h. Obesity.
(1) History of any gastrointestinal procedure for the control of obesity is
disqualifying. Artificial openings, including but not limited to ostomy
(V44) are disqualifying.
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18. Female Genitalia.
a. Uterine bleeding. Current or history of abnormal uterine bleeding (626.2),
including but not limited to menorrhagia, metrorrhagia, or polymenorrhea is
disqualifying.
b. Amenorrhea. Current unexplained amenorrhea (626.0) is disqualifying.
c. Dysmenorrhea. Current or history of dysmenorrhea (625.3) that is
incapacitating to a degree recurrently necessitating absences of more than a
few hours from routine activities is disqualifying.
d. Endometriosis. Current or history of endometriosis (617) is disqualifying.
e. Major abnormalities or defects of the genitalia. History of major
abnormalities or defects of the genitalia such as change of sex (P64.5),
hermaphroditism, pseudohermaphroditism, or pure gonadal dysgenesis
(752.7) is disqualifying.
f. Ovarian cyst(s). Current or history of ovarian cyst(s) (620.2) when persistent
or symptomatic is disqualifying.
g. Pelvic inflammatory disease. Current pelvic inflammatory disease (614) or
history of recurrent pelvic inflammatory disease is disqualifying. Current or
history of chronic pelvic pain or unspecified symptoms associated with female
genital organs (625.9) is disqualifying.
h. Pregnancy. Current pregnancy (V22) is disqualifying until six (6) months after
the end of the pregnancy.
i. Uterine absence/enlargement. History of congenital uterine absence (752.3) is
disqualifying. Current uterine enlargement due to any cause (621.2) is
disqualifying.
j. Genital infection or ulceration. Current or history of genital infection or
ulceration, including but not limited to herpes genitalis (054.11) or condyloma
acuminatum (078.11), if of sufficient severity requiring frequent intervention
or to interfere with normal function is disqualifying.
k. Abnormal gynecologic cytology. Current or history of abnormal gynecologic
cytology, including but not limited to unspecified abnormalities of the
Papanicolaou smear of the cervix (795.0), excluding Atypical Squamous Cells
of Undetermined Significance without Human Papilloma Virus (HPV) (079.4)
and confirmed Low-Grade Squamous Intraepithelial Lesion (LGSIL) (622.9)
is disqualifying. For the purposes of this Instruction, confirmation is by
colposcopy or repeat cytology.
Chapter 3. D. Page 19
COMDTINST M6000.1E
(1) A temporary waiver for one (1) year may be considered for cervical
intraepithelial neoplasia (CIN)-2/3 if the following conditions are met:
(a) It is the first occurrence of CIN-2/3;
(b) The woman has an excisional or ablative procedure for CIN-2/3;
(c) There is no evidence of invasive/micro-invasion and no involvement
of endocervical glandular components;
(2) A permanent waiver may be considered after one (1) year if the member
meets the accession standards in ref (a) at each of the quarterly follow-up
examinations during the temporary waiver period.
19. Male Genitalia.
a. Testicles absent. Absence of one or both testicles, congenital (752.89) or
undescended (752.51) is disqualifying. Unilateral loss of testis, unrelated to
cancer is not disqualifying.
b. Epispadias or hypospadias. Current epispadias (752.62) or hypospadias
(752.61), when accompanied by evidence of urinary tract infection, urethral
stricture, or voiding dysfunction, is disqualifying.
c. Testicle enlargement or epididymis. Current enlargement or mass of testicle
or epididymis (608.9) is disqualifying.
d. Orchitis or epididymitis. Current orchitis or epididymitis (604.90) is
disqualifying.
e. Penis amputation. History of penis amputation (878.0) is disqualifying.
f. Genital infection or ulceration. Current or history of genital infection or
ulceration, including but not limited to herpes genitalis (054.13) or condyloma
acuminatum (078.11), if of sufficient severity to require frequent intervention
or to interfere with normal function is disqualifying.
g. Prostatitis. Current acute prostatitis (601.0) or chronic prostatitis (601.1) is
disqualifying.
h. Hydrocele. Current hydrocele (603) with greatest dimension of four (4)
centimeters or greater or symptomatic, is disqualifying.
(1) Left varicocele (456.4), if symptomatic, or associated with testicular
atrophy, or varicocele larger than the testis, is disqualifying.
(2) Any right varicocele is disqualifying.
Chapter 3. D. Page 20
COMDTINST M6000.1E
i. Scrotal pain. Current or history of chronic scrotal pain or unspecified
symptoms associated with male genital organs (608.9) is disqualifying.
j. Genitalia abnormalities or defects. History of major abnormalities or defects
of the genitalia such as change of sex (P64.5), hermaphroditism,
pseudohermaphroditism, or pure gonadal dysgenesis (752.7) is disqualifying.
20. Urinary System.
a. Cystitis. Current cystitis, or history of chronic or recurrent cystitis (595) is
disqualifying.
b. Urethritis. Current urethritis, or history of chronic or recurrent urethritis
(597.80) is disqualifying.
c. Enuresis. History of enuresis (788.30) or incontinence of urine (788.30), or
the control of it with medication or other treatment past the fifteenth (15th)
birthday is disqualifying.
d. Urinary tract disease. Current hematuria (599.7), pyuria, or other findings
indicative of urinary tract disease (599) is disqualifying.
e. Urethral stricture or fistula. Current urethral stricture (598) or fistula (599.1)
is disqualifying.
f. Kidney.
(1) Current absence of one kidney, congenital (753.0) or acquired (V45.73), is
disqualifying.
(2) Current pyelonephritis (590.0) (chronic or recurrent), or any other
unspecified infections of the kidney (590.9) is disqualifying.
(3) Current or history of polycystic kidney (753.1) is disqualifying.
(4) Current or history of horseshoe kidney (753.3) is disqualifying.
(5) Current or history of hydronephrosis (591) is disqualifying.
(6) Current or history of acute (580) or chronic (582) nephritis of any type is
disqualifying.
(7) Current or history of proteinuria (791.0) greater than 200 milligrams in 24
hours; or a protein-to-creatinine ratio greater than 0.2 in a random urine
sample, if greater than 48 hours after strenuous activity is disqualifying,
unless consultation determines the condition to be benign orthostatic
proteinuria.
Chapter 3. D. Page 21
COMDTINST M6000.1E
(8) Current of history of urolithiasis (592) within the preceding twelve (12)
months is disqualifying. Recurrent calculus, nephrocalcinosis, or bilateral
renal calculi at any time is disqualifying.
21. Spine and Sacroiliac Joints.
a. Ankylosing spondylitis. Ankylosing spondylitis or other inflammatory
spondylopathies (720) is disqualifying.
b. Sacroiliac joints. Current or history of any condition, including but not limited
to the spine or sacroiliac joints, with or without objective signs, are
disqualifying if:
(1) It prevents the individual from successfully following a physically active
vocation in civilian life (724), or is associated with local or referred pain to
the extremities, muscular spasms, postural deformities, or limitation in
motion.
(2) Requires external support.
(3) Requires limitation of physical activity or frequent treatment.
c. Spine deviation or curvature. Current deviation or curvature of spine (737)
from normal alignment, structure, or function is disqualifying if:
(1) It prevents the individual from following a physically active vocation in
civilian life.
(2) It interferes with the proper wearing of a uniform or military equipment.
(3) It is symptomatic.
(4) There is lumbar or thoracic scoliosis greater than 30 degrees, or kyphosis
and lordosis greater than 50 degrees when measured by the Cobb Method.
d. Fusion vertebral bodies. History of congenital fusion (756.15) involving more
than two vertebral bodies or any surgical fusion of spinal vertebrae (P81.0) is
disqualifying.
e. Vertebra fracture or dislocation. Current or history of fracture or dislocation
of the vertebra (805) is disqualifying. A compression fracture involving less
than 25 percent of a single vertebra is not disqualifying if the injury occurred
more than one (1) year before examination and the applicant is asymptomatic.
A history of fractures of the transverse or spinous processes is not
disqualifying if the applicant is asymptomatic.
(1) Vertebral fractures that do not meet the standards:
Chapter 3. D. Page 22
COMDTINST M6000.1E
(a) Compression fractures involving more than or equal to 25 percent
of a single vertebra,
(b) Compression fractures involving less than 25 percent of a single
vertebra occurring within the past twelve (12) months or it is
symptomatic,
(c) Any compression fracture that is symptomatic.
(2) Vertebral fractures that meet the standard:
(a) Compression fractures involving less than 25 percent of a single
vertebra if it occurred more than twelve (12) months before the
accession exam and the applicant is asymptomatic,
(b) Fractures of the transverse or spinous process that are not
symptomatic.
f. Epiphysitis. History of juvenile epiphysitis (732.6) with any degree of
residual change indicated by X-ray or kyphosis is disqualifying.
g. Herniated nucleus pulposus. Current herniated nucleus pulposus (722) or
history of surgery to correct is disqualifying. A surgically corrected
asymptomatic single level lumbar or thoracic diskectomy with full resumption
of unrestricted activity meets the standard.
h. Spina bifida. Current or history of spina bifida (741) when symptomatic,
when there is more than one vertebral level involved or with dimpling of the
overlying skin is disqualifying. History of surgical repair of spina bifida is
disqualifying.
i. Spondylolysis. Current or history of spondylolysis congenital (756.10756.12), or acquired (738.4) and spondylolisthesis congenital (756.12) or
acquired (738.4) are disqualifying.
22. Upper Extremities.
a. Limitation of motion. Current active joint ranges of motion less than the
measurements listed in paragraphs below are disqualifying.
(1) Shoulder (726.1)
(a) Forward elevation to 90 degrees.
(b) Abduction to 90 degrees.
(2) Elbow (726.3)
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COMDTINST M6000.1E
(a) Flexion to 130 degrees.
(b) Extension to 15 degrees.
(3) Wrist (726.4). A total range of 60 degrees (extension plus flexion), or
radial and ulnar deviation combined arc 30 degrees.
(4) Hand (726.4)
(a) Pronation to 45 degrees.
(b) Supination to 45 degrees.
(5) Fingers and Thumb (726.4). Inability to clench fist, pick up a pin, grasp an
object, or touch tips of at least three fingers with thumb.
b. Hand and Finger.
(1) Absence of the distal phalanx of either thumb (885) is disqualifying.
(2) Absence of any portion of the index finger is disqualifying.
(3) Absence of distal and middle phalanx of the middle, or ring finger of either
hand irrespective of the absence of little finger (886) is disqualifying.
(4) Absence of more than the distal phalanx of any two of the following: index,
middle, or ring finger of either hand (886) is disqualifying.
(5) Absence of hand or any portion thereof (887) is disqualifying, except for
specific absence of fingers as noted above.
(6) Current polydactyly (755.0) is disqualifying.
(7) Intrinsic paralysis or weakness of upper limbs, including but not limited to
nerve paralysis, carpal tunnel and cubital syndromes, lesion of ulnar,
median, or radial nerve (354) sufficient to produce physical findings in the
hand such as muscle atrophy and weakness is disqualifying.
c. Residual Weakness and Pain. Current disease, injury, or congenital condition
with residual weakness or symptoms that prevents satisfactory performance of
duty, including but not limited to chronic joint pain associated with the
shoulder (719.41), the upper arm (719.42), the forearm (719.43), and the hand
(719.44); or chronic joint pain as a late effect of fracture of the upper
extremities (905.2), as a late effect of sprains without mention of injury
(905.7), and as late effects of tendon injury (905.8) are disqualifying.
Chapter 3. D. Page 24
COMDTINST M6000.1E
23. Lower Extremities.
a. Limitation of Motion. Current active joint ranges of motion less
than the measurements listed in the subparagraphs below are
disqualifying:
(1) Hip (due to disease (726.5) or injury (905.2)).
(a) Flexion to 90 degrees.
(b) No demonstrable flexion contracture.
(c) Extension to 10 degrees (beyond 0 degrees).
(d) Abduction to 45 degrees.
(e) Rotation of 60 degrees (internal and external combined).
(2) Knee (due to disease (726.6) or injury (905.4)).
(a) Full extension to 0 degrees.
(b) Flexion to 110 degrees.
(3) Ankle (due to disease (726.7) or injury (905.4) or congenital).
(a) Dorsiflexion to 10 degrees.
(b) Planter flexion to 30 degrees.
(c) Subtalar eversion and inversion totaling 5 degrees.
b. Foot and Ankle.
(1) Current absence of a foot or any portion thereof (896) is disqualifying.
(2) Absence of a single lesser toe or any portion thereof that is symptomatic
and does not impair function meets the standard.
(3) Deformity of the toes that prevents the proper wearing of military
footwear or impairs walking, marching, running, maintaining balance or
jumping is disqualifying.
(4) Symptomatic deformity of the toes (acquired (735) or congenital
(755.66)), including but not limited to conditions such as hallux valgus
(735.0), hallux varus (735.1), hallux rigidicus (735.2), hammer toe(s)
(735.4), claw toe(s) (735.5), or overriding toe(s) (735.8) are disqualifying.
Chapter 3. D. Page 25
COMDTINST M6000.1E
(5) Clubfoot (754.70) or pes cavus (754.71) that prevents the proper wearing
of military footwear or causes symptoms when walking, marching, running,
or jumping is disqualifying.
(6) Rigid or symptomatic pes planus (acquired (734), congenital (754.61)).
(7) Current ingrown toenails (703.0), if infected or symptomatic are
disqualifying.
(8) Current or history of plantar fasciitis (728.71) is disqualifying.
(9) Symptomatic neuroma (355.6) is disqualifying.
c. Leg, Knee, Thigh, and Hip.
(1) Current loose or foreign body in the knee joint (717.6) is disqualifying.
(2) History of uncorrected anterior (717.83) or posterior (717.84) cruciate
ligament injury is disqualifying.
(3) History of surgical reconstruction of knee ligaments (P81.4) meets the
standard if twelve (12) months has elapsed since reconstruction, and the
knee is asymptomatic and stable.
(4) Recurrent ACL reconstruction is disqualifying.
(5) Symptomatic medial (717.82) or lateral (717.42) meniscal injury is
disqualifying. The following meets the standard if asymptomatic and
released to full and unrestricted activity:
(a) Meniscal repair, at greater than six (6) months after surgery.
(b) Partial meniscectomy at greater than three (3) months after surgery.
(6) Meniscal transplant is disqualifying.
(7) Symptomatic medial and lateral collateral ligament instability is
disqualifying.
(8) Current or history of congenital dislocation of the hip (754.3),
osteochondritis of the hip (Legg-Perthes Disease) (732.1), or slipped
capital femoral epiphysis of the hip (732.2) is disqualifying.
(9) Hip dislocation (835) within two (2) years preceding examination is
disqualifying. Hip dislocation after two (2) years meets the standard if
asymptomatic and released to full unrestricted activity.
Chapter 3. D. Page 26
COMDTINST M6000.1E
(10) Symptomatic osteochondritis of the tibial tuberosity (OsgoodSchlatter Disease) (732.4) within the past twelve (12) months is
disqualifying.
(11) Stress fractures, recurrent or single episode during the past twelve (12)
months are disqualifying.
d. General.
(1) Current deformities, disease, or chronic joint pain of pelvic region, thigh
(719.45), lower leg (719.46), knee (717.9), ankle and/or foot (719.47) that
have interfered with function to such a degree as to prevent the individual
from following a physically active vocation in civilian life, or that would
interfere with walking, running, weight bearing, or the satisfactory
completion of training or military duty are disqualifying.
(2) Current leg-length discrepancy resulting in a limp (736.81) is
disqualifying.
24. Miscellaneous Conditions of the Extremities.
a. Chondromalacia. Current or history of chondromalacia (717.7), including but
not limited to chronic patello-femoral pain syndrome and retro-patellar pain
syndrome, osteoarthritis (715.3), or traumatic arthritis (716.1) is disqualifying.
b. Dislocations of any major joints. Current joint dislocation if unreduced, or
history of recurrent dislocations/subluxations or instability of the hip (835),
elbow (832), ankle (837), or foot is disqualifying.
c. History of any dislocation/subluxations or instability of the knee (718.86) or
shoulder (831).
d. Osteoarthritis. Current or history of chronic osteoarthritis (715.3) or traumatic
arthritis (716.1) of isolated joints that has interfered with a physically active
lifestyle, or that prevents the satisfactory performance of military duty is
disqualifying.
e. Fractures.
(1) Current malunion or non-union of any fracture (733.8) (except
asymptomatic ulnar styloid process fracture) is disqualifying.
(2) Current retained hardware (including plates, pins, rods, wires, or screws)
used for fixation that is symptomatic or interferes with proper wearing of
protective equipment or military uniform. Retained hardware is not
disqualifying if fractures are healed, ligaments are stable, and there is no
pain.
Chapter 3. D. Page 27
COMDTINST M6000.1E
f. Orthopedic implants. Current orthopedic implants or devices to correct
congenital or post-traumatic orthopedic abnormalities (V43) are disqualifying.
g. Bone or joint contusion. Current or history of contusion of bone or joint; an
injury of more than a minor nature which shall interfere or prevent
performance of military duty, or shall require frequent or prolonged treatment,
without fracture, nerve injury, open wound, crush or dislocation, which
occurred in the preceding six (6) months and recovery has not been
sufficiently completed or rehabilitation resolved are disqualifying.
h. Joint replacement. History of joint replacement of any site (V43.6) is
disqualifying.
i. Muscular paralysis, contracture, or atrophy. Current or history of
neuromuscular paralysis, weakness, contracture, or atrophy (728), of sufficient
degree to interfere with or prevent satisfactory performance of military duty,
or requires frequent or prolonged treatment, is disqualifying.
j. Osteochondroma or osteocartilaginous exostoses. Current symptomatic
osteochondroma or history of multiple osteocartilaginous exostoses (727.82)
are disqualifying.
k. Osteoporosis. Current osteoporosis (733.0) as demonstrated by a reliable test
such as a DEXA scan is disqualifying.
l. Osteopenia. Current osteopenia (733.9) until resolved is disqualifying.
m. Osteomyelitis. Current osteomyelitis (730.0) or history of recurrent
osteomyelitis is disqualifying.
n. Osteochondritis desiccans. Current or history of osteochondritis desiccans
(732.7) is disqualifying.
o. History of cartilage surgery to include but not limited to cartilage
debridement, chondroplasty, microfracture, or cartilage transplant procedure
are disqualifying.
p. Compartment Syndrome. Current or history of any post-traumatic (958.9) or
exercise induced (729.7-79) compartment syndrome is disqualifying.
q. Avascular Necrosis. Current or history of avascular necrosis of any bone is
disqualifying.
r. Tendon Disorders. Current or history of recurrent tendon disorder including
but not limited to tendonitis, tendonopathy, or tenosynovitis are disqualifying.
25. Vascular System.
Chapter 3. D. Page 28
COMDTINST M6000.1E
a. Arteries and blood vessels. Current or history of abnormalities of the arteries
(447), including but not limited to aneurysms (442), arteriovenous
malformations, atherosclerosis (440), or arteritis (such as Kawasaki’s disease)
(446), are disqualifying.
b. Vascular disease. Current or medically managed hypertension (401) is
disqualifying. Hypertension is defined as systolic pressure greater than 140
mmHg and/or diastolic pressure greater than 90 mmHg confirmed by manual
blood pressure (BP) cuff averaged over two or more properly measured,
seated, blood pressure readings on each of two or more consecutive days
(isolated, single day BP elevation is not disqualifying unless confirmed on two
or more consecutive days).
c. Peripheral vascular disease. Current or history of peripheral vascular disease
(443.9), including but not limited to diseases such as Raynaud's Disease
(443.0), and vasculidities are disqualifying.
d. Venous diseases. Current or history of venous diseases, including but not
limited to recurrent thrombophlebitis (451), thrombophlebitis during the
preceding year, or evidence of venous incompetence, such as large or
symptomatic varicose veins, edema, or skin ulceration (454) are disqualifying.
26. Skin and Cellular Tissues.
a. Sebaceous glands. Current diseases of sebaceous glands including severe
and/or cystic acne (706), or hidradenitis, suppurativa (705), scalp
perifollicular (704) if extensive involvement of the neck, scalp, axilla, groin,
shoulders, chest, or back is present or shall be aggravated by or interfere with
the proper wearing of military equipment are disqualifying. Applicants under
treatment with systemic retinoids, including but not limited to isotretinoin
(Accutane ®), are disqualified until eight (8) weeks after completion of
therapy.
b. Current or history of atopic dermatitis (691) or eczema (692.9) after the
twelfth (12th) birthday.
(1) Atopic Dermatitis. Active or history of residual or recurrent lesions in
characteristic areas (face, neck, antecubital and/or popliteal fossae,
occasionally wrists and hands) are disqualifying.
(2) Non-Specific Dermatitis. Current or history of recurrent or chronic nonspecific dermatitis to include contact dermatitis (692) (irritant/allergic), or
dyshydrotic dermatitis (705.81) requiring more treatment than with over
the counter medications is disqualifying.
d. Cysts.
Chapter 3. D. Page 29
COMDTINST M6000.1E
(1) Current cyst (706.2) (other than pilonidal cyst) is of such a size or location
as to interfere with the proper wearing of military equipment is
disqualifying.
(2) Current pilonidal cyst (685) is evidenced by the presence of a tumor mass
or a discharging sinus, or is a surgically resected pilonidal cyst that is
symptomatic, unhealed, or less than six (6) months post-operative is
disqualifying.
e. Bullous dermatoses. Current or history of bullous dermatoses (694), including
but not limited to dermatitis herpetiformis, pemphigus, and epidermolysis
bullosa (757.39), is disqualifying. Resolved bullous impetigo meets the
standards.
f. Lymphedema. Current or chronic lymphedema (457.1) is disqualifying.
g. Furunculosis or carbuncle. Current or history of furunculosis or carbuncle
(680) if extensive, recurrent, or chronic is disqualifying.
h. Hyperhidrosis of hands or feet. Current or history of severe hyperhidrosis of
hands or feet (705.2, 780.8), unless controlled by topical medications is
disqualifying.
i. Skin anomalies congenital or acquired. Current or history of congenital (757)
or acquired (216) anomalies of the skin, such as nevi or vascular tumors that
interfere with function, or are exposed to constant irritation are disqualifying.
History of Dysplastic Nevus Syndrome is disqualifying (232).
j. Keloid formation. Current or history of keloid formation (701.4), including
pseudofolliculitis and keloidalis nuchae (706.1), if that tendency is marked or
interferes with the proper wearing of military equipment is disqualifying.
k. Lichen planus. Current lichen planus (cutaneous and/or oral) (697.0) is
disqualifying.
l. Neurofibromatosis. Current or history of neurofibromatosis (Von
Recklinghausen's Disease) (237.7) is disqualifying.
m. Photosensitivity. History of photosensitivity (692.72), including but not
limited to any primary sun-sensitive condition, such as polymorphous light
eruption or solar urticaria, or any dermatosis aggravated by sunlight, such as
lupus erythematosus is disqualifying.
n. Psoriasis, Radiodermatitis, scleroderma. Current or history of psoriasis
(696.1) is disqualifying. Current or history of radiodermatitis (692.82) is
disqualifying. Current or history of scleroderma (710.1) is disqualifying.
Chapter 3. D. Page 30
COMDTINST M6000.1E
o. Urticaria. Current or history of chronic urticaria lasting longer than six (6)
weeks or recurrent episodes of urticaria (708.8) within the past two (2) years
not associated with angioedema, hereditary angioedema (277.6) or
maintenance therapy for chronic urticaria, even if not symptomatic is
disqualifying.
p. Plantar wart(s). Current symptomatic plantar wart(s) (078.19) is
disqualifying.
q. Scars or any other chronic skin disorder. Current scars (709.2), or any other
chronic skin disorder of a degree or nature that requires frequent outpatient
treatment or hospitalization, which in the opinion of the certifying authority
shall interfere with proper wearing of military clothing or equipment, or which
exhibits a tendency to ulcerate or interferes with the satisfactory performance
of duty is disqualifying.
r. Prior burn (949) injury involving 18 percent or more of the body surface area
(including graft sites), or resulting in functional impairment to such a degree,
due to scarring, as to interfere with the satisfactory performance of military
duty to decreased range of motion, strength, or agility.
s. Fungus infections. Current localized types of fungus infections (117),
interfering with the proper wearing of military equipment or the performance
of military duties are disqualifying. For systemic fungal infections, refer to
paragraph 28.v.
27. Blood and Blood-Forming Tissues.
a. Anemia. Current hereditary or acquired anemia, which has not been corrected
with therapy before appointment or induction is disqualifying. For the
purposes of this Instruction, anemia is defined as a hemoglobin of less than
13.5 for males and less than 12 for females. Use the following ICD-9 codes for
diagnosed anemia: hereditary hemolytic anemia (282), sickle cell disease
(282.6), acquired hemolytic anemia (283), aplastic anemia (284), or
unspecified anemias (285).
b. Coagulation defects. Current or history of coagulation defects (286) including
but not limited to von Willebrand's Disease (286.4), idiopathic
thrombocytopenia (287), Henoch-Schönlein Purpura (287.0) are disqualifying.
c. Agranulocytosis and/or leukopenia. Current or history of diagnosis of any
form of chronic or recurrent agranulocytosis and/or leukopenia (288.0) is
disqualifying.
28. Systemic.
a. Immunodeficiencies. Current or history of disorders involving the immune
mechanism, including immunodeficiencies (279) is disqualifying. Presence of
Chapter 3. D. Page 31
COMDTINST M6000.1E
Human Immunodeficiency Virus or serologic evidence of infection (042) is
disqualifying. False positive screening test(s) with ambiguous results on
confirmatory immunologic testing is disqualifying.
b. Lupus. Current or history of lupus erythematosus (710.0) or mixed
connective tissue disease variant (710.9) is disqualifying.
c. Sclerosis. Current or history of progressive systemic sclerosis (710.1),
including CRST Variant is disqualifying. A single plaque of localized
Scleroderma (morphea) that has been stable for at least two (2) years is not
disqualifying.
d. Reiter's disease. Current or history of Reiter's disease (099.3) is disqualifying.
e. Rheumatoid arthritis. Current or history of rheumatoid arthritis (714.0) is
disqualifying.
f. Sjögren's syndrome. Current or history of Sjögren's syndrome (710.2) is
disqualifying.
g. Vasculitis. Current or history of vasculitis, including but not limited to
polyarteritis nodosa and allied conditions (446.0), arteritis (447.6), Behçet's
(136.1), and Wegner's granulomatosis (446.4) is disqualifying.
h. Tuberculosis (010).
(1) Current active tuberculosis or substantiated history of active tuberculosis
in any form or location, regardless of past treatment, in the previous two (2)
years is disqualifying.
(2) Current residual physical or mental defects from past tuberculosis that
shall prevent the satisfactory performance of duty are disqualifying.
(3) Individuals with a past history of active tuberculosis greater than two (2)
years before appointment, enlistment, or induction are qualified if they have
received a complete course of standard chemotherapy for tuberculosis.
(4) Current or history of untreated latent tuberculosis (positive Purified
Protein Derivative with negative chest x-ray) (795.5) is disqualifying.
Individuals with a tuberculin reaction in accordance with American
Thoracic Society (ATS) and U.S. Public Health Service (USPHS)
guidelines are eligible for enlistment, induction, and appointment,
provided they have received chemoprophylaxis in accordance with
ATS and USPHS guidelines. A negative QuantiFERON®-TB Gold
(QFT®-G) with a positive tuberculin skin test meets the standard.
i. Syphilis. Current untreated syphilis is disqualifying (097).
Chapter 3. D. Page 32
COMDTINST M6000.1E
j. Anaphylaxis. History of anaphylaxis (995.0) is disqualifying.
(1) History of anaphylaxis to stinging insects (989.5) is disqualifying. A
cutaneous only reaction to a stinging insect under the age of sixteen (16)
meets the standard. Applicants who have been treated for 3-5 years with
maintenance venom immunotherapy meet the standard.
(2) History of systemic allergic reaction to food or food additives (995.60995.69) are disqualifying. Systemic allergic reaction may be defined as a
temporally related, systemic, often multi-system, reaction to a specific food.
The presence of a food-specific immunoglobulin E antibody without a
correlated clinical history meets the standard.
(3) Oral allergy syndrome is disqualifying.
(4) Hypersensitivity to latex is disqualifying.
(5) Exercise induced anaphylaxis (with or without food) is disqualifying.
(6) Idiopathic anaphylaxis is disqualifying.
(7) Acute, early, or immediate anaphylactic onset is disqualifying.
(8) History of angioedema or urticaria is disqualifying.
k. Tropical fevers. Current residual of tropical fevers, including but not limited
to fevers, such as malaria (084) and various parasitic or protozoan infestations
that prevent the satisfactory performance of military duty is disqualifying.
l. Sleep disturbances. Current sleep disturbances (780.5), including but not
limited to sleep apneas or narcolepsy or history of narcolepsy is disqualifying.
m. Malignant hyperthermia. History of malignant hyperthermia (995.86) is
disqualifying.
n. Industrial solvent or other chemical intoxication. History of industrial solvent
or other chemical intoxication (982) with sequelae is disqualifying.
o
Motion sickness. History of motion sickness (994.6) resulting in recurrent
incapacitating symptoms or of such a severity to require pre-medication in the
previous three (3) years is disqualifying.
p. Rheumatic fever. History of rheumatic fever (390) is disqualifying.
q. Muscular dystrophies. Current or history of muscular dystrophies (359) or
myopathies is disqualifying.
r. Amyloidosis. Current or history of amyloidosis (277.3) is disqualifying.
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s. Granuloma. Current or history of eosinophilic granuloma (277.8) is
disqualifying. Healed eosinophilic granuloma, when occurring as a single
localized bony lesion and not associated with soft tissue or other involvement
meets the standard. All other forms of the Histiocytosis (202.3) are
disqualifying.
t. Polymyositis /dermatomyositis. Current or history of polymyositis (710.4)
/dermatomyositis complex (710.3) with skin involvement is disqualifying.
u. Rhabdomyolysis / Sarcoidosis. History of rhabdomyolysis (728.88) is
disqualifying. Current or history of sarcoidosis (135) is disqualifying.
v. Fungus infections. Current systemic fungus infections (117) are
disqualifying. For localized fungal infections, refer to paragraph 26.s.
29. Endocrine and Metabolic.
a. Adrenal dysfunction. Current or history of adrenal dysfunction (255) is
disqualifying.
b. Diabetes mellitus. Current or history of diabetes mellitus (250) is
disqualifying.
c. Pituitary dysfunction. Current or history of pituitary dysfunction (253) is
disqualifying.
d. Gout. Current or history of gout (274) is disqualifying.
e. Hyperparathyroidism or hypoparathyroidism. Current or history of
hyperparathyroidism (252.0) or hypoparathyroidism (252.1) is
disqualifying.
f. Thyroid Disorders.
(1) Current goiter (240) is disqualifying.
(2) Current hypothyroidism (244) uncontrolled by medication is
disqualifying.
(3) Current or history of hyperthyroidism (242.9) is disqualifying.
(4) Current thyroiditis (245) is disqualifying.
g. Nutritional deficiency diseases. Current nutritional deficiency
diseases, including but not limited to beriberi (265), pellagra (265.2),
and scurvy (267) are disqualifying.
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h. Glycosuria. Current persistent Glycosuria, when associated with
impaired glucose tolerance (250) or renal tubular defects (271.4) is
disqualifying.
i. Acromegaly. Current or history of Acromegaly, including but not
limited to gigantism (253.0), or other disorders of pituitary function
(253) is disqualifying.
30. Neurologic.
a. Cerebrovascular conditions. Current or history of cerebrovascular conditions,
including but not limited to subarachnoid (430) or intracerebral (431)
hemorrhage, vascular insufficiency, aneurysm or arteriovenous malformation
(437) are disqualifying.
b. Central nervous system anomalies. History of congenital or acquired
anomalies of the central nervous system (742) or meningocele (741.9) is
disqualifying.
c. Meninges disorders. Current or history of disorders of meninges, including but
not limited to cysts (349.2) is disqualifying.
d. Hereditodegenerative disorders. Current or history of degenerative and
hereditodegenerative disorders, including but not limited to those disorders
affecting the cerebrum (330), basal ganglia (333), cerebellum (334), spinal
cord (335), or peripheral nerves (337) are disqualifying.
e. Headaches. History of recurrent headaches (784.0), including but not limited
to migraines (346) and tension headaches (307.81) that interfere with normal
function in the past three (3) years, or of such severity to require prescription
medications are disqualifying.
f. Head Injury. (854.0)
(1) History of severe head injury shall be disqualifying if associated with any of
the following:
(a) Post-traumatic seizure(s) occurring more than 30 minutes after injury.
(b) Persistent motor or sensory deficits.
(c) Impairment of intellectual function.
(d) Alteration of personality.
(e) Unconsciousness, amnesia, or disorientation of person, place, or time
of 24-hours duration or longer post-injury.
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(f) Multiple fractures involving skull or face (804).
(g) Cerebral laceration or contusion (851).
(h) History of epidural, subdural, subarachnoid, or intracerebral hematoma
(852).
(i) Associated abscess (326) or meningitis (958.8).
(j) Cerebrospinal fluid rhinorrhea (349.81) or otorrhea (388.61) persisting
more than seven (7) days.
(k) Focal neurologic signs.
(l) Radiographic evidence of retained foreign body or bony fragments
secondary to the trauma and/or operative procedure in the brain.
(m) Leptomeningeal cysts or Arteriovenous Fistula (447.0).
(2) History of moderate head injury (854.03) is disqualifying. After two (2)
years post-injury, applicants may be qualified if neurological consultation
shows no residual dysfunction or complications. Moderate head injuries are
defined as unconsciousness, amnesia, or disorientation of person, place, or
time alone or in combination, of more than 1 and less than 24-hours
duration post-injury, or linear skull fracture.
(3) History of mild head injury (854.02) is disqualifying. After 1 month postinjury, applicants may be qualified if neurological evaluation shows no
residual dysfunction or complications. Mild head injuries are defined as a
period of unconsciousness, amnesia, or disorientation of person, place, or
time, alone or in combination of 1 hour or less post-injury.
(4) History of persistent post-traumatic symptoms (310.2) that interfere with
normal activities or have duration of greater than 1 month is disqualifying.
Such symptoms include, but are not limited to headache, vomiting,
disorientation, spatial disequilibrium, impaired memory, poor mental
concentration, shortened attention span, dizziness, or altered sleep patterns.
g. Infectious Diseases of the Central Nervous System.
(1) Current or history of acute infectious processes of the central nervous
system, including but not limited to meningitis (322), encephalitis (323),
or brain abscess (324), are disqualifying if occurring within one (1) year
before examination, or if there are residual neurological defects.
(2) History of neurosyphilis (094) of any form, including but not limited to
general paresis, tabes dorsalis, or meningovascular syphilis, is disqualifying.
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COMDTINST M6000.1E
h. Paralysis, weakness, lack of coordination, chronic pain, or sensory
disturbance. Current or history of paralysis, weakness, lack of coordination,
chronic pain, or sensory disturbance or other specified paralytic syndromes
(344) is disqualifying.
i. Epilepsy. Any seizure occurring beyond the 6th birthday, unless the applicant
has been free of seizures for a period of 5 years while taking no medication
for seizure control, and has a normal electroencephalogram (EEG) is
disqualifying. All such applicants shall have a current neurology consultation
with current EEG results (345).
j. Nervous system disorders. Chronic nervous system disorders, including but
not limited to myasthenia gravis (358.0), multiple sclerosis (340), and tic
disorders (307.20) (e.g., Tourette's (307.23)) are disqualifying.
k. Central nervous system shunts. Current or history of retained central nervous
system shunts of all kinds (V45.2) are disqualifying.
l. Narcolepsy or cataplexy. Current or history of narcolepsy or cataplexy (347)
is disqualifying.
31. Learning Psychiatric and Behavioral.
a. Attention Deficit Hyperactivity Disorder. Attention Deficit Hyperactivity
Disorder (ADHD) (314) does not meet the standard unless the following
criteria are met:
(1) The applicant has not required an Individualized Education Program or
work accommodations since the age of 14.
(2) There is no history of comorbid mental disorders.
(3) The applicant has never taken more than a single daily dosage of
medication or has not been prescribed medication for this condition for
more than 24 cumulative months after the age of 14.
(4) During periods off of medication after the age of 14, the applicant has
been able to maintain at least a 2.0 grade point average without
accommodations.
(5) Documentation from the applicant’s prescribing provider that continued
medication is not required for acceptable occupational or work
performance.
(6) Applicant is required to enter Service and pass Service specific training
periods with no prescribed medication for ADHD.
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COMDTINST M6000.1E
b. Learning Disorders. History of learning disorders (315), including but not
limited to dyslexia (315.02), do not meet the standard unless the applicants
demonstrated passing academic and employment performance without
utilization or recommendation of academic and/or work accommodations at
any time since age 14.
c. Pervasive Developmental Disorders. Pervasive Developmental Disorders
(299 series) including Asperger Syndrome, Autistic Spectrum Disorders, and
Pervasive Developmental Disorder-Not Otherwise Specified (299.9) is
disqualifying.
d. Psychotic features. Current or history of disorders with psychotic features
such as schizophrenic disorders (295), delusional disorders (297), or other and
unspecified psychoses (298) is disqualifying.
e. Bipolar Disorders/Psychoses. History of bipolar disorders (296.4-7) and
affective psychoses (296.8) are disqualifying.
f. Depressive disorders. History of depressive disorders (296), Dysthymic
(300.4), Cyclothymic (301.11) requiring outpatient care for longer than twelve
(12) months by a physician or other mental health professional (to include
V65.40), or any inpatient treatment in a hospital or residential facility is
disqualifying.
g. Depressive disorders not otherwise specified (311), or unspecified mood
disorder (296.90), does not meet the standards unless:
(1) Outpatient care was not required for longer than twenty-four (24) months
(cumulative) by a physician or other mental health professional (V65.40).
(2) Has been stable without treatment for the past thirty-six (36) continuous
months.
(3) Did not require any inpatient treatment in a hospital or residential facility.
h. Adjustment disorders. History of a single adjustment disorder (309) within
the previous three (3) months, or recurrent episodes of adjustment disorders
are disqualifying.
i. Conduct or behavior disorders. Current or history of disturbance of conduct
(312), impulse control (312.3), oppositional defiant (313.81), other behavior
disorders (313), or personality disorder (301) are disqualifying.
(1) History (demonstrated by repeated inability to maintain reasonable
adjustment in school, with employers or fellow workers, or social groups),
interview, psychological testing revealing that the degree of immaturity,
instability, of personality inadequacy, impulsiveness, or dependency shall
interfere with adjustment in the Armed Forces.
Chapter 3. D. Page 38
COMDTINST M6000.1E
(2) Recurrent encounters with law enforcement agencies (excluding minor
traffic violations) or antisocial behaviors are tangible evidence of impaired
capacity to adapt to military service.
j. Other behavior disorders. Current or history of other behavior disorders is
disqualifying, including but not limited to conditions such as the following:
(1) Enuresis (307.6) as defined in current edition of Diagnostic and Statistical
Manual of Mental Disorders, after 15th birthday.
(2) Encopresis (307.7) after 13th birthday.
(3) Somnambulism (sleepwalking) (307.4) or a single episode of sleepwalking
after 15th birthday.
k. Eating Disorders. History of anorexia nervosa (307.1) or bulimia (307.51) are
disqualifying. Other eating disorders (307.50; 52-54) including unspecified
disorders of eating (307.59) occurring after the 13th birthday are disqualifying.
l. Receptive or expressive language disorder. Any current receptive or
expressive language disorder, including but not limited to any speech
impediment, stammering and stuttering (307.0) of such a degree as to
significantly interfere with production of speech or to repeat commands is
disqualifying.
m. Suicidal behavior. History of suicidal behavior, including gesture(s) or
attempt(s) (300.9), or history of self-mutilation or injury used as a way of
dealing with life and emotions is disqualifying.
n. Obsessive-compulsive/Posttraumatic Stress Disorder. History of obsessivecompulsive disorder (300.3), or posttraumatic stress disorder (309.81) are
disqualifying.
o. Anxiety disorders. History of anxiety disorders (300.01), anxiety order not
otherwise specified (300.00), panic disorder (300.2), agoraphobia (300.21,
300.22), social phobia (300.23), simple phobias (300.29), other acute
reactions to stress (308) are disqualifying unless:
(1) The applicant did not require any treatment in an inpatient or residential
facility.
(2) Outpatient care was not required for longer than twelve (12) months
(cumulative) by a physician or other mental health professional (to include
V65.40).
(3) The applicant has not required treatment (including medication) for the
past 24 continuous months.
Chapter 3. D. Page 39
COMDTINST M6000.1E
(4) The applicant has been stable without loss of time from normal pursuits
for repeated periods even if of brief duration; and without symptoms or
behavior of a repeated nature which impaired social, school, or work
efficiency for the past 24 continuous months.
p. Dissociative disorders. Current or history of dissociative disorders,
conversion, or factitious disorders (300.1), or depersonalization (300.6) are
disqualifying.
q. Somatoform disorders. Current or history of somatoform disorders (300.8),
hypochondriasis (300.7), or pain disorder related to psychological factors
(307.80 and .89) are disqualifying.
r. Psychosexual conditions. Current or history of psychosexual conditions
(302), including but not limited to transsexualism, exhibitionism,
transvestism, voyeurism, and other paraphilias are disqualifying.
s. Alcohol dependence, abuse. Current or history of alcohol dependence (303),
drug dependence (304), alcohol abuse (305), or other drug abuse (305.2 thru
305.9) is disqualifying.
t. Mental disorders. Current or history of other mental disorders (all 290-319
not listed above) that, in the opinion of the civilian or military provider, shall
interfere with or prevent satisfactory performance of military duty are
disqualifying.
u. Prior psychiatric hospitalization for any cause.
32. Tumors and Malignancies.
a. Tumors. Current benign tumors (M8000) or conditions that interfere with
function, prevent the proper wearing of the uniform or protective equipment,
shall require frequent specialized attention, or have a high malignant potential,
such as Dysplastic Nevus Syndrome are disqualifying.
b. Malignant tumors. Current or history of malignant tumors (V10) is
disqualifying. Skin cancer (other than malignant melanoma) removed with no
residual is not disqualifying.
33. Miscellaneous.
a. Parasitic diseases. Current or history of parasitic diseases, if symptomatic or
carrier state, including but not limited to filariasis (125), trypanosomiasis
(086), schistosomiasis (120), hookworm (uncinariasis) (126.9), unspecified
infectious and parasitic disease (136.9) are disqualifying.
Chapter 3. D. Page 40
COMDTINST M6000.1E
b. Frequent or prolonged treatment. Current or history of other disorders,
including but not limited to cystic fibrosis (277.0), or porphyria (277.1), that
prevent satisfactory performance of duty or require frequent or prolonged
treatment are disqualifying.
c. Cold-related disorders. Current or history of cold-related disorders, including
but not limited to frostbite, chilblain, immersion foot (991), or cold urticaria
(708.2), are disqualifying. Current residual effects of cold-related disorders,
including but not limited to paresthesias, easily traumatized skin, cyanotic
amputation of any digit, ankylosis, trench foot, or deep-seated ache are
disqualifying.
d. Angioedema. History of angioedema, including hereditary angioedema (277.6)
is disqualifying.
e. Organ or tissue transplantation. History of receiving organ or tissue
transplantation (V42) is disqualifying.
f. Pulmonary or systemic embolization. History of pulmonary (415) or systemic
embolization (444) is disqualifying.
g. Metallic poisoning. History of untreated acute or chronic metallic poisoning,
including but not limited to lead, arsenic, silver (985), beryllium, or manganese
(985) is disqualifying. Current complications or residual symptoms of such
poisoning are disqualifying.
h. Heat pyrexia heatstroke or sunstroke. History of heat pyrexia (992.0),
heatstroke (992.0), or sunstroke (992.0) is disqualifying. History of three or
more episodes of heat exhaustion (992.3) is disqualifying. Current or history of
a predisposition to heat injuries, including disorders of sweat mechanism,
combined with a previous serious episode is disqualifying. Current or history
of any unresolved sequelae of heat injury, including but not limited to nervous,
cardiac, hepatic or renal systems is disqualifying.
i. Interference of performance of duty. Current or history of any condition that in
the opinion of the Medical Officer shall significantly interfere with the
successful performance of military duty or training is disqualifying (should use
specific ICD code whenever possible, or 796.9).
j. Pathological conditions. Any current acute pathological condition, including
but not limited to acute communicable diseases, until recovery has occurred
without sequelae is disqualifying.
Chapter 3. D. Page 41
COMDTINST M6000.1E
Evaluation for Risk of Head Injury Sequelae
DEGREE OF HEAD
INJURY
MINIMUM REQUIRED
WAITING PERIOD
EVALUATION
REQUIREMENTS
MILD
ONE MONTH
COMPLETE
NEUROLOGICAL
EXAMINATION BY
A PHYSICIAN
MODERATE
TWO YEARS
COMPLETE
NEUROLOGICAL
EVALUATION BY A
NEUROLOGIST OR
INTERNIST
CT SCAN
SEVERE
PERMANENT
DISQUALIFICATION
COMPLETE
NEUROLOGICAL
EVALUATION BY
NEUROLOGIST OR
NEUROSURGEON
CT SCAN
NEUROPSYCHOLO
GICAL
EVALUATION
Chapter 3. D. Page 42
Figure 3-D-1
COMDTINST M6000.1E
Classification and Comparative Nomenclature of Cervical Smears
Original Classification
CIN System
Class I: No abnormal cells
Normal smear;
Class II: Atypical cells present
below the level of
cervical neoplasia
Bethesda System
Atypical squamous
cells of undetermined
significance
Class III: Smear contains abnormal
cells consistent with
dysplasia
Mild dysplasia = CIN1
Moderate dysplasia =
CIN2
Low-grade SIL
(Changes associated with HPV & CIN1)
Class IV Smear contains abnormal
cells consistent with
carcinoma-in-situ
Severe dysplasia and
carcinoma-in-situ =
CIN3
High-grade SIL
(CIN2, CIN3, and
carcinoma-in-situ)
Class V: Smear contains abnormal
1. cells consistent with carcinoma
2.
squamous cell carcinoma
Abbreviations:
CIN = cervical intraepithelial neoplasia
SIL = squamous intraepithelial lesion
Chapter 3. D. Page 43
Squamous cell carcinoma
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Chapter 3. D. Page 44
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Section E. Physical Standards for Programs Leading to Commission
1.
2.
3.
4.
5.
6.
7.
8.
Appointment as Cadet, United States CG Academy ...............................................1
Commissioning of Cadets ........................................................................................2
Enrollment as an Officer Candidate.........................................................................2
Commissioning of Officer Candidates.....................................................................3
CG Direct Commission Program .............................................................................4
Direct Commission in the CG Reserve ....................................................................4
Direct Commission of Licensed Officers of U. S. Merchant Marine ......................4
Appointment to Warrant Grade ...............................................................................4
Chapter 3. E. Page i
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Chapter 3. E. Page ii
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E. Physical Standards for Programs Leading to Commission.
1.
Appointment as Cadet, USCG Academy.
a.
Physical Examinations.
(1) Applicants are encouraged to review the physical standards as
published in the Academy Bulletin with their private physician prior to
submitting their application for cadet candidate. This review serves to
rule out, at this stage of the potential cadet's processing, applicants who
obviously will not meet the required physical standards for
appointment. In some cases, the physician may recommend a complete
physical examination. Inaccuracy in ascertaining defects and
determining the candidate's physical status at the time of this review
results in unnecessary work for the CG and disappointment to the
candidate when defects are subsequently found during the formal
physical examination.
(2) Candidates and their parents and sponsors are urged to refrain from
requesting waivers for medical defects. The CG bases its decision to
disqualify an individual on medical facts revealed in a thorough
physical examination. Candidates unable to satisfy the minimum
requirements are not suited for commission in the Regular CG, and
consequently are not eligible for training at the Academy. A request
for waiver for a medical defect invariably results in disappointment to
all concerned.
(3) Two physical examinations are required:
(a) Formal physical examination before appointment is tendered.
(b) Pre-training examination at the time of reporting to the Academy.
(4) Formal physical examinations prior to accepting of candidates must be
performed by a U. S. Public Health Service, Navy, Army, Air Force, or
Veteran's Administration Medical Officer authorized to perform each
exam by Department of Defense Medical Examination Review Board
(DODMERB). All candidates are instructed where to report for such
examinations.
b.
Physical Standards. All candidates for the CG Academy must meet the
physical standards for enrollment as an officer candidate. DODMERB is
reviewing authority.
c.
Retention. The standards for retention of a cadet at the Academy are the
same as those for enrollment as an officer candidate, except that the
Superintendent of the Academy is authorized to establish physical fitness
and weight control programs designed to have cadets maintain weight
closer to the ideal than the standards stipulated elsewhere for Service
personnel. These stricter goals during cadet years are intended to take
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COMDTINST M6000.1E
advantage of the Academy's unique environment of rigorous physical
activity combined with opportunities for diet control and weight
monitoring. These programs will instill lifelong behavior patterns to
support the Service weight control standards.
2.
Commissioning of Cadets. The pre-appointment physical examination of cadets
in the graduating class should be held at least 6 months prior to acceptance of
the commission. This physical examination should be conducted to determine
physical fitness for commission in the Regular Service (section 3-D and 3-E)
with recommendations made accordingly. Cadets should not be summarily
disqualified for commissioning merely because they do not meet the standards
for appointment as cadets provided that they may reasonably be expected to be
physically capable of completing a full and effective CG career. In general,
relatively minor defects that would be disqualifying for original commission
direct from civilian life are not disqualifying for commission of a cadet in whom
the Government has a considerable investment.
3.
Enrollment as an Officer Candidate.
a.
Physical Examination. The physical examination for an officer candidate
must be conducted by a Medical Officer and a Dentist. Particular care must
be exercised during the examination in order that candidates may not be
rejected later as a result of reexamination at Officer Candidate School. A
complete physical examination is given officer candidates upon arrival at
OCS to determine medical fitness and freedom from disease. Physician
Assistant Officer Candidates will only receive an initial OCS candidate
physical.
b.
Physical Standards for Enrollment. The standards contained in section 3-D
(section 3-F for enlisted OCS candidates), as modified below, are applicable
for enrollment as an officer candidate. Conditions not enumerated, that in
the medical examiner's opinion will not permit a full productive career,
shall be recorded in detail with appropriate recommendations.
(1) Distant Visual Acuity. Uncorrected visual acuity shall be not worse
than20/400 in either eye provided that vision is correctable to 20/20 and
that refractive error does not exceed plus or minus 8.0 diopters
spherical equivalent (sphere + 1/2 cylinder), astigmatism does not
exceed 3.00 diopters, and anisometropia does not exceed 3.50 diopters.
Eyes must be free from any disfiguring or incapacitating abnormality
and from acute or chronic disease. All personnel requiring corrective
lenses shall wear them for the performance of duty.
(2) Near visual acuity of any degree that does not correct to 20/40 in the
better eye.
(3) Normal color perception.
(4) Teeth.
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COMDTINST M6000.1E
(a) All candidates shall be given a Type II dental examination by a
dental officer, as part of the pre-training physical examination.
(b) Caries. No more than four teeth may exhibit multi-surface caries.
(c) Endodontics. The need for endodontic intervention on seven or
more canals is disqualifying.
(d) Maxillary and Mandibular Bones. Malunited fractures of
maxillary or mandibular bones and deformities of maxillary or
mandibular bones interfering with mastication or speech are
disqualifying. The presences of extensive necrosis or osseous
lesions requiring surgical intervention are also disqualifying.
(e) Oral Tissues. Extensive loss of oral tissues that would prevent the
replacement of missing teeth with a satisfactory prosthetic
appliance is disqualifying. Unresolved oral inflammatory diseases
are disqualifying. Hypertrophic, hyperplastic, or leukoplakic
conditions of the soft tissue of the oral cavity may be disqualifying
and will be considered on a case-by-case basis.
(f) Periodontal Disease. The presence of advanced periodontal
disease is disqualifying.
(g) Serviceable Teeth. A sufficient number of teeth, natural or
artificial, in functional occlusion to assure satisfactory incision,
mastication, and phonation are required. The minimum
requirement is edentulous upper and lower jaws corrected by full
dentures. A requirement for placement of a prosthesis to meet the
above requirements is disqualifying.
(h) Temporomandibular Joint. Current symptoms and/or history of
chronic temporomandibular joint dysfunction is disqualifying (see
also section 3-D-16.b).
(i) Orthodontics. Candidates with active appliances will need to
submit a waiver request for continuing active orthodontic treatment
as described in Chapter 2 Section A. 3. e. of this Manual.
4.
Commissioning of Officer Candidates.
a.
The physical examination given upon arrival at OCS precludes the need for
a commissioning physical examination providing there has been no
intervening change in physical status and a visual acuity and color
perception examination are given prior to actual commissioning.
Chapter 3. E. Page 3
COMDTINST M6000.1E
b.
The physical standards for commissioning are the same as for enrollment as
an officer candidate. Final determination as to physical fitness for
commissioning is made by the Commandant.
5.
CG Direct Commission Program. Physical standards for CG active duty
members (CWO’s, Enlisted) that apply for the Direct Commission program are
the same as for retention of officers in the regular CG. Refer to Section F of this
Manual for the standards. Physical standards for all other applicants are the
same as for enrollment of officer candidates.
6.
Direct Commission in the CG Reserve.
7.
a.
Non-aviator. The physical examination and standards for direct
commission in the Reserve are the same for enrollment of officer
candidates, except that Ready Reserve Direct Commission (RRDC)
examinations must be within 24 months prior to the date of execution of the
Acceptance and Oath of Office (CG-9556).
b.
Aviator. Candidates for direct commission in the Reserve as aviators must
obtain an aviation physical examination from a currently qualified
uniformed services Flight Surgeon or AMO within the last 12 months. The
candidate must meet the standards for Class I, contained in section 3-G.
Direct Commission of Licensed Officers of U. S. Merchant Marine.
a. Physical Examination. Two physical examinations are required: a
preliminary physical at the time of the written examination; and a preappointment physical examination taken by successful candidates within six
months of actual commission. The physical examination must be conducted
by a Medical Officer of the uniformed services on active duty. Final
determination of physical fitness will be made by the Commandant.
b. Physical Standards. The physical standards for direct commission of
Licensed Officers of the U. S. Merchant Marine are the same as for
enrollment of officer candidates. All these standards must be met without
waiver.
8.
Appointment to Warrant Grade.
a. Physical Examination. A complete physical examination is required within
12 months prior to appointment to Warrant Officer, except that physical
examinations for members of the CG Ready Reserve must be within 24
months prior to the date of execution of the Acceptance and Oath of Office
(CG-9556).
Chapter 3. E. Page 4
COMDTINST M6000.1E
b. Physical Requirements. The physical standards for appointment of CG
members to Warrant Officer are the same as for retention of officers in the
regular CG. Refer to Section 3-F of this Manual for the standards. Physical
standards for all other applicants are the same as for enrollment of officer
candidates.
Chapter 3. E. Page 5
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Chapter 3. E. Page 6
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Section F. Physical Standards Applicable to All Personnel (Regular and Reserve) For:
Reenlistment; Enlistment of Prior Service USCG Personnel; Retention; Overseas
Duty; and Sea Duty
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
General Instructions .................................................................................................1
Use of List of Disqualifying Conditions and Defects ..............................................1
Head and Neck .........................................................................................................2
Esophagus, Nose, Pharynx, Larynx, and Trachea ...................................................2
Eyes ..........................................................................................................................2
Ears and Hearing ......................................................................................................5
Lungs and Chest Wall ..............................................................................................5
Heart and Vascular System ......................................................................................7
Abdomen and Gastrointestinal System ....................................................................9
Endocrine and Metabolic Conditions (Diseases) ...................................................11
Genitourinary System ............................................................................................12
Extremities .............................................................................................................14
Spine, Scapulae, Ribs, and Sacroiliac Joints..........................................................17
Skin and Cellular Tissues.......................................................................................18
Neurological Disorders ..........................................................................................19
Psychiatric Disorders. (see section 5-B concerning disposition) ...........................20
Dental .....................................................................................................................21
Blood and Blood-Forming Tissue Diseases ...........................................................21
Systemic Diseases, General Defects, and Miscellaneous Conditions....................22
Tumors and Malignant Diseases ............................................................................23
Sexually Transmitted Infection ..............................................................................23
Human Immunodeficiency Virus (HIV) ................................................................23
Transplant recipient ...............................................................................................24
Chapter 3. F. Page i
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Chapter 3. F. Page ii
COMDTINST M6000.1E
F. Physical Standards Applicable to All Personnel (Regular and Reserve) For:
Reenlistment; Enlistment of Prior Service USCG Personnel; Retention; Overseas
Duty; and Sea Duty.
1.
General Instructions.
a.
Scope. This section establishes specific physical standards applicable to all
personnel (regular and reserve) for:
(1) Enlistment/reenlistment of prior service USCG personnel within 6 months of
discharge from active duty in the regular CG.
(2) Retention.
(3) Overseas duty.
(4) Sea duty.
2.
b.
Physical Examinations. Physical examinations should be conducted by at least one
Medical and one Dental Officer of the uniformed services or by contract
physician/dentist.
c.
Fitness for Duty. Members are ordinarily considered fit for duty unless they have a
physical impairment (or impairments) that interferes with the performance of the
duties of their grade or rating. A determination of fitness or unfitness depends
upon the individual's ability to reasonably perform those duties. Active duty or
reserves on extended active duty considered permanently unfit for duty shall be
referred to a Medical Evaluation Board (MEB) for appropriate disposition.
Reservists in any status not found ‘fit for duty’ six months after
incurring/aggravating an injury or illness, or reservists who are unlikely to be found
‘fit for duty’ within six months after incurring/aggravating an injury or illness shall
be referred to a Medical Evaluation Board. See Reserve Policy Manual,
COMDTINST M1001.28 (series), Chapter 6, “Reserve Incapacitation System”.
Use of List of Disqualifying Conditions and Defects. This section lists certain medical
conditions and defects that are normally disqualifying. However, it is not an allinclusive list. Its major objective is to achieve uniform disposition of cases arising
under the law, but it is not a mandate that possession of one or more of the listed
conditions or physical defects (and any other not listed) means automatic retirement or
separation. If the member’s condition is disqualifying but he/she can perform his/her
duty, a waiver request could be submitted in lieu of immediate referral to a Medical
Evaluation Board. If the request is denied, then a Medical Evaluation Board is required.
The only exception is HIV infection, which may not require waiver or referral to MEB
if the member continues to fully perform duties. (see Chapter 3- F-22 of this Manual).
Chapter 3. F. Page 1
COMDTINST M6000.1E
3.
4.
Head and Neck.
a.
Loss of substance of the skull. With or without prosthetic replacement when
accompanied by moderate residual signs and symptoms.
b.
Torticollis (wry neck). Severe fixed deformity with cervical scoliosis, flattening of
the head and face, and loss of cervical mobility.
Esophagus, Nose, Pharynx, Larynx, and Trachea.
a.
Esophagus.
(1) Achalasia. Manifested by dysphagia (not controlled by dilation), frequent
discomfort, inability to maintain normal vigor and nutrition, or requiring
frequent treatment.
(2) Esophagitis. Persistent and severe.
(3) Diverticulum of the esophagus. Of such a degree as to cause frequent
regurgitation, obstruction and weight loss, that does not respond to treatment.
(4) Stricture of the esophagus. Of such a degree as to almost restrict diet to
liquids, require frequent dilation and hospitalization, and cause difficulty in
maintaining weight and nutrition.
b.
Larynx.
(1) Paralysis of the larynx. Characterized by bilateral vocal cord paralysis
seriously interfering with speech or adequate airway.
(2) Stenosis of the larynx. Causing respiratory embarrassment upon more than
minimal exertion.
(3) Obstruction edema of glottis. If chronic, not amenable to treatment and
requiring tracheotomy.
c.
Nose, Pharynx, Trachea.
(1) Rhinitis. Atrophic rhinitis characterized by bilateral atrophy of nasal mucous
membrane with severe crusting and concomitant severe headaches.
(2) Sinusitis. Severe and chronic that is suppurative, complicated by polyps, and
does not respond to treatment.
(3) Trachea. Stenosis of trachea that compromises airflow to more than a mild
degree.
5.
Eyes.
a.
Diseases and Conditions.
(1) Active eye disease or any progressive organic disease regardless of the stage of
activity, that is resistant to treatment and affects the distant visual acuity or
visual field so that the member fits into one of the following:
Chapter 3. F. Page 2
COMDTINST M6000.1E
(a) Distant visual acuity does not meet the standards.
(b) The diameter of the field of vision in the better eye is less than 20°.
(2) Aphakia, bilateral. Regardless of lens implant(s).
(3) Atrophy of optic nerve.
(4) Glaucoma. If resistant to treatment, or affecting visual fields, or if side effects
of required medications are functionally incapacitating.
(5) Diseases and infections of the eye. When chronic, more than mildly
symptomatic, progressive and resistant to treatment after a reasonable period.
(6) Ocular manifestations of endocrine or metabolic disorders. Not disqualifying,
per se; however, residuals or complications, or the underlying disease may be
disqualifying.
(7) Residuals or complications of injury. When progressive or when reduced
visual acuity or fields do not meet the standards.
(8) Retina, detachment of.
(a) Unilateral.
1. When visual acuity does not meet the standards.
2. When the visual field in the better eye is constricted to less than 20°.
3. When uncorrectable diplopia exists.
4. When detachment results from organic progressive disease or new
growth, regardless of the condition of the better eye.
(b) Bilateral. Regardless of etiology or results of corrective surgery.
b.
Vision.
(1) Aniseikonia. Subjective eye discomfort, neurologic symptoms, sensations of
motion sickness and other gastrointestinal disturbances, functional
disturbances and difficulties in form sense, and not corrected by iseikonic
lenses.
(2) Binocular diplopia. Which is severe, constant, and in zone less than 20° from
the primary position.
(3) Hemianopsia. Of any type, if bilateral, permanent, and based on an organic
defect. Those due to a functional neurosis and those due to transitory
conditions, such as periodic migraine, are not normally disqualifying.
(4) Night blindness. Of such a degree that the individual requires assistance in any
travel at night.
(5) Visual Acuity.
Chapter 3. F. Page 3
COMDTINST M6000.1E
(a) Visual acuity that cannot be corrected to at least 20/50 in the better eye.
(b) Complete blindness or enucleation of an eye.
(c) When vision is correctable only by the use of contact lenses or other
corrective device (telescope lenses, etc.).
(6) Visual Fields. When the visual field in the better eye is constricted to less than
20°.
(7) Color Perception. Normal color perception is required for retention of
commissioned officers (certain warrant officer specialties do not require
normal color perception) and selected ratings [See the Personnel Manual,
COMDTINST M1000.6(series) Chapter 5-B]. The testing for color vision
must be unaided or with standard corrective lenses only. Use of any lenses
(such as Chromagen) or other device to compensate for defective color vision
is prohibited. Retesting for color perception is normally not required if results
of previous tests are documented in the health record, and there has been no
history of a change in color vision. Exception: At the time of accession
medical screening (e.g. CG Academy (including cadets and OCS candidates),
Cape May recruits) the PIP color vision test will be repeated and normal color
vision confirmed under controlled conditions as described in Chapter 3 Section
C 22.i of this manual. Examinees are qualified if they pass either the
Pseudoisochromatic Plates (PIP) or the Farnsworth Lantern (FALANT) test.
Examinees who fail the PIP are qualified if they pass the FALANT.
c.
Corneal Refractive Surgery.
(1) The refractive surgery procedures radial keratotomy (RK), and intracorneal
rings (ICR) are disqualifying.
(2) Corneal Refractive Surgery for aviation personnel and candidates is discussed
in Chapter 3. Section G.13 of this Manual.
(3) Photorefractive keratectomy (PRK) or Laser Assisted in situ Keratomileusis
(LASIK) is not disqualifying for non-aviation members, including diving
personnel, and does not require a waiver if the following conditions are met:
(a) Must follow guidelines for elective health care contained in 2.A.6.
Note: Personnel having any type of corneal refractive surgery shall not
perform duties requiring stable eyesight (e.g. deck watch, boat crew, etc.)
until medically cleared.
(b) There must be post surgical refractive stability defined as less than 0.50
diopter changes over two separate exams at least three months apart.
(c) Must meet all vision standards in 3-F.5.b (divers must meet vision
standards in 3-H.2.h). If the member is unable to meet these standards
they will be considered for separation as outlined in the Physical
Disability Evaluation System, COMDTINST M1850.2 (series).
Chapter 3. F. Page 4
COMDTINST M6000.1E
(4) Implantable Contact Lenses (ICL) are not disqualifying and do not need a
waiver if the following conditions are met: (Does not apply to aviation
personnel)
(a) Must follow guidelines for elective health care contained in 2.A.6
(b) Must meet retention vision standards by three months post operatively.
6.
Ears and Hearing.
a.
Ears.
(1) Infections of the external auditory canal. Chronic and severe, resulting in
thickening and excoriation of the canal, or chronic secondary infection
requiring frequent and prolonged medical treatment and hospitalization
(2) Malfunction of the acoustic nerve. Evaluate hearing impairment.
(3) Mastoiditis, chronic. Constant drainage from the mastoid cavity, requiring
frequent and prolonged medical care.
(4) Mastoidectomy. Followed by chronic infection with constant or recurrent
drainage requiring frequent or prolonged medical care.
(5) Meniere's syndrome. Recurring attacks of sufficient frequency and severity as
to interfere with satisfactory performance of military duty, or require frequent
or prolonged medical care.
(6) Otitis Media. Moderate, chronic, suppurative, resistant to treatment, and
necessitating frequent or prolonged medical care.
b.
7.
Hearing. Retention will be determined on the basis of ability to perform duties of
grade or rating.
Lungs and Chest Wall.
a.
Tuberculous (TB) Lesions. See www.cdc.gov/tb/.
(1) Pulmonary tuberculosis.
(a) When an active duty member's disease is found to be not incident to
military service, or when treatment and return to useful duty will probably
require more than 15 months, including an appropriate period of
convalescence, or if expiration of service will occur before completion of
period of hospitalization. (Career members who express a desire to
reenlist after treatment may extend their enlistment to cover period of
hospitalization.)
(b) When a Reservist not on active duty has TB that will probably require
treatment for more that 12 to 15 months including an appropriate period of
convalescence before being able to perform full-time military duty.
Individuals who are retained in the Reserve while undergoing treatment
may not be called or ordered to active duty (including mobilization),
Chapter 3. F. Page 5
COMDTINST M6000.1E
active duty for training, or inactive duty training during the period of
treatment and convalescence.
b.
Non-tuberculous Conditions. Pulmonary diseases, other than acute infections, must
be evaluated in terms of respiratory function, manifested clinically by
measurements that must be interpreted as exertional or altitudinal tolerance.
Symptoms of cough, pain, and recurrent infections may limit a member's activity.
Many of the conditions listed below may coexist and in combination may produce
unfitness.
(1) Atelectasis, or massive collapse of the lung. Moderately symptomatic with
paroxysmal cough at frequent intervals throughout the day, or with moderate
emphysema, or with residuals or complications that require repeated
hospitalization.
(2) Bronchial Asthma. Associated with emphysema of sufficient severity to
interfere with the satisfactory performance of duty, or with frequent attacks not
controlled by inhaled or oral medications, or requiring oral corticosteroids
more than twice a year.
(3) Bronchiectasis or bronchiolectasis. Cylindrical or saccular type that is
moderately symptomatic, with productive cough at frequent intervals
throughout the day, or with moderate other associated lung disease to include
recurrent pneumonia, or with residuals or complications that require repeated
hospitalization.
(4) Bronchitis. Chronic, severe persistent cough, with considerable expectoration,
or with moderate emphysema, or with dyspnea at rest or on slight exertion, or
with residuals or complications that require repeated hospitalization.
(5) Cystic disease of the lung, congenital. Involving more than one lobe of a lung.
(6) Diaphragm, congenital defect. Symptomatic.
(7) Hemopneumothorax, hemothorax, or pyopneumothorax. More than moderate
pleuritic residuals with persistent underweight, or marked restriction of
respiratory excursion and chest deformity, or marked weakness and fatigability
on slight exertion.
(8) Histoplasmosis. Chronic and not responding to treatment.
(9) Pleurisy, chronic or pleural adhesions. Severe dyspnea or pain on mild
exertion associated with definite evidence of pleural adhesions and
demonstrable moderate reduction of pulmonary function.
(10) Pneumothorax, spontaneous. Repeated episodes of pneumothorax not
correctable by surgery.
(11) Pneumoconiosis. Severe with dyspnea on mild exertion.
(12) Pulmonary calcification. Multiple calcifications associated with significant
respiratory embarrassment or active disease not responsive to treatment.
Chapter 3. F. Page 6
COMDTINST M6000.1E
(13) Pulmonary emphysema. Marked emphysema with dyspnea on mild exertion
and demonstrable moderate reduction in pulmonary function.
(14) Pulmonary fibrosis. Linear fibrosis or fibrocalcific residuals that cause
dyspnea on mild exertion and demonstrable moderate reduction in pulmonary
function.
(15) Pulmonary sarcoidosis. If not responding to therapy and complicated by
demonstrable moderate reduction in pulmonary function.
(16) Stenosis, bronchus. Severe stenosis associated with repeated attacks of
bronchopulmonary infections requiring frequent hospitalization.
c.
8.
Surgery of the Lungs and Chest. Lobectomy. If pulmonary function (ventilatory
tests) is impaired to a moderate degree or more.
Heart and Vascular System.
a.
Heart.
(1) Arrhythmias. Associated with organic heart disease, or if not adequately
controlled by medication or if they interfere with satisfactory performance of
duty.
(2) Arteriosclerotic disease. Associated with congestive heart failure, repeated
anginal attacks, or objective evidence of myocardial infarction.
(3) Endocarditis. Bacterial endocarditis resulting in myocardial insufficiency or
associated with valvular heart disease.
(4) Heart block. Associated with other symptoms of organic heart disease or
syncope (Stokes-Adams Syndrome).
(5) Myocarditis and degeneration of the myocardium. Myocardial insufficiency
resulting in slight limitation of physical activity.
(6) Pericarditis.
(a) Chronic constrictive pericarditis unless successful remedial surgery has
been performed.
(b) Chronic serous pericarditis.
(7) Rheumatic valvulitis and valvular heart disease. Cardiac insufficiency at
functional capacity and therapeutic level of class IIC or worse, American Heart
Association. A diagnosis made during the initial period of service or
enlistment that is determined to be a residual of a condition that existed prior to
entry in the service is disqualifying regardless of severity.
b.
Vascular System.
(1) Arteriosclerosis obliterans. When any of the following pertain:
Chapter 3. F. Page 7
COMDTINST M6000.1E
(a) Intermittent claudication of sufficient severity to produce pain and
inability to complete a walk of 200 yards or less on level ground at 112
steps per minute without a rest.
(b) Objective evidence of arterial disease with symptoms of claudication,
ischemic chest pain at rest, or with gangrenous or permanent ulcerative
skin changes in the distal extremity.
(c) Involvement of more than one organ system or anatomic region (the lower
extremities comprise one region for this purpose) with symptoms of
arterial insufficiency.
(2) Congenital anomalies. Coarctation of aorta and other congenital anomalies of
the cardiovascular system unless satisfactorily treated by surgical correction.
(3) Aneurysms. Aneurysm of any vessel not correctable by surgery and producing
limiting symptomatic conditions precluding satisfactory performance of duty.
Aneurysm corrected by surgery but with residual limiting symptomatic
conditions that preclude satisfactory performance of duty.
(a) Satisfactory performance of duty is precluded because of underlying
recurring or progressive disease producing pain, dyspnea, or similar
symptomatic limiting conditions.
1. Reconstructive surgery including grafts, when prosthetic devices are
attached to or implanted in the heart.
2. Unproven procedures have been accomplished and the patient is
unable to satisfactorily perform duty or cannot be returned to duty
under circumstances permitting close medical supervision.
(4) Periarteritis nodosa. With definite evidence of functional impairment.
(5) Chronic venous insufficiency (postphlebitic syndrome). When more than mild
and symptomatic despite elastic support.
(6) Raynaud's phenomenon. Manifested by trophic changes of the involved part
characterized by scarring of the skin or ulceration.
(7) Thrombophlebitis. When repeated attacks require such frequent treatment as
to interfere with satisfactory performance of duty.
(8) Varicose veins. Severe and symptomatic despite therapy.
(9) Any condition requiring anti-thrombotic medication other than aspirin.
c.
Miscellaneous.
(1) Erythromelalgia. Persistent burning pain in the soles or palms not relieved by
treatment.
(2) Hypertensive cardiovascular disease and hypertensive vascular disease.
Chapter 3. F. Page 8
COMDTINST M6000.1E
(a) Diastolic pressure consistently more than 90 mm Hg following an
adequate period of therapy on an ambulatory status; or
(b) Any documented history of hypertension regardless of the pressure values
if associated with one or more of the following:
1. Cerebrovascular symptoms.
2. Arteriosclerotic heart disease if symptomatic and requiring treatment.
3. Kidney involvement, manifested by unequivocal impairment of renal
function.
4. Grade III (Keith-Wagener-Barker) changes in the fundi.
(3) Rheumatic fever, active, with or without heart damage. Recurrent attacks.
(4) Residual of surgery of the heart, pericardium, or vascular system under one or
more of the following circumstances:
(a) When surgery of the heart, pericardium, or vascular system results in
inability of the individual to perform duties without discomfort or
dyspnea.
(b) When the surgery involves insertion of a pacemaker, reconstructive
vascular surgery employing exogenous grafting material.
(c) Similar newly developed techniques or prostheses, the individual is unfit.
9.
Abdomen and Gastrointestinal System.
a.
Defects and Diseases.
(1) Achalasia. Manifested by dysphagia not controlled by dilation with frequent
discomfort, or inability to maintain normal vigor and nutrition.
(2) Amebic abscess residuals. Persistent abnormal liver function tests and failure
to maintain weight and normal vigor after appropriate treatment.
(3) Biliary dyskinesia. Frequent abdominal pain not relieved by simple
medication, or with periodic jaundice.
(4) Cirrhosis of the liver. Recurrent jaundice or ascites; or demonstrable
esophageal varices or history of bleeding there from.
(5) Gastritis. Severe, chronic gastritis with repeated symptomatology and
hospitalization and confirmed by gastroscopic examination.
(6) Hepatitis, chronic. When, after a reasonable time (1 to 2 years) following the
acute stage, symptoms persist, and there is objective evidence of impaired liver
function.
Chapter 3. F. Page 9
COMDTINST M6000.1E
(7) Hernia.
(a) Hiatus hernia. Severe symptoms not relieved by dietary or medical
therapy, or recurrent bleeding in spite of prescribed treatment.
(b) Other. If operative repair is contraindicated for medical reasons or when
not amenable to surgical repair.
(8) Ileitis, regional (Crohn’s disease). Except when responding well to ordinary
treatment other than oral corticosteroids or immune-suppressant medications.
(9) Pancreatitis, chronic. Frequent severe abdominal pain; or steatorrhea or
disturbance of glucose metabolism requiring hypoglycemic agents.
(10) Peritoneal adhesions. Recurring episodes of intestinal obstruction
characterized by abdominal colicky pain, vomiting, and intractable
constipation requiring frequent hospital admissions.
(11) Proctitis, chronic. Moderate to severe symptoms of bleeding, or painful
defecation, tenesmus, and diarrhea, with repeated hospital admissions.
(12) Ulcer, peptic, duodenal, or gastric. Repeated incapacitation or absences from
duty because of recurrence of symptoms (pain, vomiting, or bleeding) in spite
of good medical management, and supported by laboratory, x-ray, and
endoscopic evidence of activity.
(13) Ulcerative colitis. Except when responding well to ordinary treatment.
(14) Rectum, stricture of. Severe symptoms of obstruction characterized by
intractable constipation, pain on defecation, difficult bowel movements
requiring the regular use of laxatives or enemas, or requiring repeated
hospitalization.
b.
Surgery.
(1) Colectomy, partial. When more than mild symptoms of diarrhea remain or if
complicated by colostomy.
(2) Colostomy. When permanent.
(3) Enterostomy. When permanent.
(4) Gastrectomy.
(a) Total.
(b) Subtotal, with or without vagotomy, or gastrojejunostomy, when, in spite
of good medical management, the individual develops one of the
following:
1. "Dumping syndrome" that persists for 6 months postoperatively.
2. Frequent episodes of epigastric distress with characteristic circulatory
symptoms or diarrhea persisting 6 months postoperatively.
Chapter 3. F. Page 10
COMDTINST M6000.1E
3. Continues to demonstrate significant weight loss 6 months
postoperatively. Preoperative weight representative of obesity should
not be taken as a reference point in making this assessment.
4. Not to be confused with "dumping syndrome," and not ordinarily
considered as representative of unfitness are: postoperative symptoms
such as moderate feeling of fullness after eating; the need to avoid or
restrict ingestion of high carbohydrate foods; the need for daily
schedule of a number of small meals with or without additional
"snacks."
(5) Gastrostomy. When permanent.
(6) Ileostomy. When permanent.
(7) Pancreatectomy.
(8) Pancreaticoduodenostomy, pancreaticogastrostomy, pancreaticojejunostomy.
Followed by more than mild symptoms of digestive disturbance, or requiring
insulin.
(9) Proctectomy.
(10) Proctopexy, proctoplasty, proctorrhaphy, or proctotomy. If fecal incontinence
remains after appropriate treatment.
(11) Bariatric Surgery and all other forms of weight loss surgery are not authorized.
A waiver may be granted for individuals who have had surgery prior to July
01, 2007 and remain world wide deployable. Any complications arising from
this surgery that would compromise fitness for duty or world wide deployment
may result in separation as a result of PDES action or administrative separation
regardless of previously granted waivers
10. Endocrine and Metabolic Conditions (Diseases).
a.
Acromegaly. With function impairment.
b.
Adrenal hyperfunction. That does not respond to therapy satisfactorily or where
replacement therapy presents serious problems in management.
c.
Adrenal hypofunction. Requiring medication for control.
d.
Diabetes Insipidus. Unless mild, with good response to treatment.
e.
Diabetes Mellitus. When requiring insulin or not well controlled by oral
medications. Diabetes is considered well controlled when the glycohemoglobin is
within the normal range. Waivers will be considered on a case-by-case basis for
the use of non-insulin injectable medications e.g. Exenatide.
f.
Goiter. With symptoms of breathing obstruction with increased activity, unless
correctable.
g.
Gout. With frequent acute exacerbations in spite of therapy, or with severe bone,
joint, or kidney damage.
Chapter 3. F. Page 11
COMDTINST M6000.1E
h.
Hyperinsulinism. When caused by a malignant tumor, or when the condition is not
readily controlled.
i.
Hyperparathyroidism. When residuals or complications of surgical correction such
as renal disease or bony deformities preclude the reasonable performance of
military duty.
j.
Hyperthyroidism. Severe symptoms, with or without evidence of goiter, that do not
respond to treatment.
k.
Hypoparathyroidism. With objective evidence and severe symptoms not controlled
by maintenance therapy.
l.
Hypothyroidism. With objective evidence and severe symptoms not controlled by
medication.
m. Osteomalacia. When residuals after therapy preclude satisfactory performance of
duty.
11. Genitourinary System.
a.
Genitourinary conditions.
(1) Cystitis. When complications or residuals of treatment themselves preclude
satisfactory performance of duty.
(2) Dysmenorrhea. Symptomatic, irregular cycle, not amenable to treatment, and
of such severity as to necessitate recurrent absences of more than l day/month.
(3) Endometriosis. Symptomatic and incapacitating to degree that necessitates
recurrent absences of more than 1 day/month.
(4) Hypospadias. Accompanied by chronic infection of the genitourinary tract or
instances where the urine is voided in such a manner as to soil clothes or
surroundings, and the condition is not amenable to treatment.
(5) Incontinence of urine. Due to disease or defect not amenable to treatment and
so severe as to necessitate recurrent absences from duty.
(6) Menopausal syndrome, physiologic or artificial. With more than mild mental
and constitutional symptoms.
(7) Strictures of the urethra or ureter. Severe and not amenable to treatment.
(8) Urethritis, chronic. Not responsive to treatment and necessitating frequent
absences from duty.
b.
Kidney.
(1) Calculus in kidney. Bilateral, recurrent, or symptomatic and not responsive to
treatment.
(2) Congenital abnormality. Bilateral, resulting in frequent or recurring infections,
or when there is evidence of obstructive uropathy not responding to medical or
surgical treatment.
Chapter 3. F. Page 12
COMDTINST M6000.1E
(3) Cystic kidney (polycystic kidney). When symptomatic and renal function is
impaired, or if the focus of frequent infection.
(4) Glomerulonephritis, chronic.
(5) Hydronephrosis. More than mild, or bilateral, or causing continuous or
frequent symptoms.
(6) Hypoplasia of the kidney. Associated with elevated blood pressure or frequent
infections and not controlled by surgery.
(7) Nephritis, chronic.
(8) Nephrosis.
(9) Perirenal abscess. With residuals that preclude satisfactory performance of
duty.
(10) Pyelonephritis or pyelitis. Chronic, that has not responded to medical or
surgical treatment, with evidence of persistent hypertension, eyeground
changes, or cardiac abnormalities.
(11) Pyonephrosis. Not responding to treatment.
c. Genitourinary and Gynecological Surgery.
(1) Cystectomy.
(2) Cystoplasty. If reconstruction is unsatisfactory or if residual urine persists in
excess of 50 cc or if refractory symptomatic infection persists.
(3) Nephrectomy. When, after treatment, there is infection or pathology in the
remaining kidney.
(4) Nephrostomy. If drainage persists.
(5) Oophorectomy. When, following treatment and convalescent period, there
remain incapacitating mental or constitutional symptoms.
(6) Penis, amputation of.
(7) Pyelostomy. If drainage persists.
(8) Ureterocolostomy.
(9) Ureterocystostomy. When both ureters are markedly dilated with irreversible
changes.
(10) Ureterocystostomy, cutaneous.
(11) Ureteroplasty.
(a) When unilateral procedure is unsuccessful and nephrectomy is necessary,
consider on the basis of the standard for a nephrectomy.
(b) When bilateral, evaluate residual obstruction or hydronephrosis and
consider unfitness on the basis of the residuals involved.
(12) Ureterosigmoidostomy.
Chapter 3. F. Page 13
COMDTINST M6000.1E
(13) Ureterostomy. External or cutaneous.
(14) Urethrostomy. When a satisfactory urethra cannot be restored.
12. Extremities.
a.
Upper.
(1) Amputations. Amputation of part or parts of an upper extremity equal to or
greater than any of the following:
(a) A thumb proximal to the interphalangeal joints.
(b) Two fingers of one hand.
(c) One finger, other than the little finger, at the metacarpophalangeal joint
and the thumb of the same hand at the interphalangeal joint.
(2) Joint ranges of motion. Motion that does not equal or exceed the
measurements listed below. Measurements must be made with a goniometer
and conform to the methods illustrated in 3-F-EXHIBIT 1.
(a) Shoulder.
1. Forward elevation to 90° .
2. Abduction to 90° .
(b) Elbow.
1. Flexion to 100° .
2. Extension to 60° .
(c) Wrist. A total range, extension plus flexion, of 15°
(d) Hand. For this purpose, combined joint motion is the arithmetic sum of
the motion at each of the three finger joints.
1. An active flexor value of combined joint motions of 135° in each of
two or more fingers of the same hand.
2. An active extensor value of combined joint motions of 75° in each of
the same two or more fingers.
3. Limitation of motion of the thumb that precludes apposition to at least
two finger tips.
(3) Recurrent dislocations of the shoulder. When not repairable or surgery is
contraindicated.
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COMDTINST M6000.1E
b.
Lower.
(1) Amputations.
(a) Loss of a toe or toes that precludes the ability to run, or walk without a
perceptible limp, or to engage in fairly strenuous jobs.
(b) Any loss greater than that specified above to include foot, leg, or thigh.
(2) Feet.
(a) Hallux valgus. When moderately severe, with exostosis or rigidity and
pronounced symptoms; or severe with arthritic changes.
(b) Pes Planus. Symptomatic more than moderate, with pronation on weight
bearing that prevents wearing military shoes, or when associated with
vascular changes.
(c) Talipes cavus. When moderately severe, with moderate discomfort on
prolonged standing and walking, metatarsalgia, or that prevents wearing a
military shoe.
(3) Internal derangement of the knee. Residual instability following remedial
measures, if more than moderate; or with recurring episodes of effusion or
locking, resulting in frequent incapacitation.
(4) Joint ranges of motion. Motion that does not equal or exceed the
measurements listed below. Measurements must be made with a goniometer
and conform to the methods illustrated in 3-F-EXHIBIT 2.
(a) Hip.
1. Flexion to 90° .
2. Extension to 0 .
(b) Knee.
1. Flexion to 90° .
2. Extension to 15°.
(c) Ankle.
1. Dorsiflexion to 10°.
2. Plantar Flexion to 10°.
(5) Shortening of an extremity, which exceeds two inches.
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COMDTINST M6000.1E
c.
Miscellaneous.
(1) Arthritis.
(a) Due to infection. Associated with persistent pain and marked loss of
function with x-ray evidence and documented history of recurring
incapacity for prolonged periods.
(b) Due to trauma. When surgical treatment fails or is contraindicated and
there is functional impairment of the involved joint that precludes
satisfactory performance of duty.
(c) Osteoarthritis. Severe symptoms associated with impaired function,
supported by x-ray evidence and documented history of recurrent
incapacity for prolonged periods.
(d) Rheumatoid arthritis or rheumatoid myositis. Substantiated history of
frequent incapacitating and prolonged periods supported by objective and
subjective findings.
(e) Seronegative Spondylarthropaties. Severe symptoms associated with
impaired function, supported by X-ray evidence and documented history
of recurrent incapacity for prolonged periods.
(2) Chondromalacia or Osteochondritis Dessicans. Severe, manifested by frequent
joint effusion, more than moderate interference with function or with severe
residuals from surgery.
(3) Fractures.
(a) Malunion. When, after appropriate treatment, there is more than moderate
malunion with marked deformity or more than moderate loss of function.
(b) Nonunion. When, after an appropriate healing period, the nonunion
precludes satisfactory performance of military duty.
(c) Bone fusion defect. When manifested by more than moderate pain or loss
of function.
(d) Callus, excessive, following fracture. When functional impairment
precludes satisfactory performance of duty and the callus does not respond
to adequate treatment.
(4) Joints.
(a) Arthroplasty. With severe pain, limitation of motion and function.
(b) Bony or fibrous ankylosis. Severe pain involving major joints or spinal
segments in an unfavorable position, or with marked loss of function.
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COMDTINST M6000.1E
(c) Contracture of joint. Marked loss of function and the condition is not
remediable by surgery.
(d) Loose bodies within a joint. Marked functional impairment complicated
by arthritis that precludes favorable treatment or not remediable by
surgery.
(5) Muscles.
(a) Flaccid paralysis of one or more muscles, producing loss of function that
precludes satisfactory performance of duty following surgical correction
or if not remediable by surgery.
(b) Spastic paralysis of one or more muscles producing loss of function that
precludes satisfactory performance of duty.
(6) Myotonia congenita.
(7) Osteitis deformans. Involvement of single or multiple bones with resultant
deformities, or symptoms severely interfering with function.
(8) Osteoarthropathy, hypertrophic, secondary. Moderately severe to severe pain
present with joint effusion occurring intermittently in one or multiple joints
and with at least moderate loss of function.
(9) Osteomyelitis, chronic. Recurrent episodes not responsive to treatment, and
involving the bone to a degree that interferes with stability and function.
(10) Tendon transplant. Fair or poor restoration of function with weakness that
seriously interferes with the function of the affected part.
13. Spine, Scapulae, Ribs, and Sacroiliac Joints.
a.
Congenital anomalies.
(1) Spina bifida. Demonstrable signs and moderate symptoms of root or cord
involvement.
(2) Spondylolysis or spondylolisthesis. With more than mild symptoms resulting
in repeated hospitalization or significant assignment limitation.
b.
Coxa vara. More than moderate with pain, deformity, and arthritic changes.
c.
Herniation of nucleus pulposus. More than mild symptoms following appropriate
treatment or remediable measures, with sufficient objective findings to demonstrate
interference with the satisfactory performance of duty.
d.
Kyphosis. More than moderate, or interfering with function, or causing unmilitary
appearance.
e.
Scoliosis. Severe deformity with over two inches of deviation of tips of spinous
processes from the midline.
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COMDTINST M6000.1E
14. Skin and Cellular Tissues.
a.
Acne. Severe, unresponsive to treatment, and interfering with the satisfactory
performance of duty or wearing of the uniform or other military equipment.
b.
Atopic dermatitis. More than moderate or requiring periodic hospitalization.
c.
Amyloidosis. Generalized.
d.
Cysts and tumors. See section 3-F-20.
e.
Dermatitis herpetiformis. If fails to respond to therapy.
f.
Dermatomyositis.
g.
Dermographism. Interfering with satisfactory performance of duty.
h.
Eczema, chronic. Regardless of type, when there is more than minimal
involvement and the condition is unresponsive to treatment and interferes with the
satisfactory performance of duty.
i.
Elephantiasis or chronic lymphedema. Not responsive to treatment.
j.
Epidermolysis bullosa.
k.
Erythema multiforme. More than moderate and chronic or recurrent.
l.
Exfoliative dermatitis. Chronic.
m. Fungus infections, superficial or systemic. If not responsive to therapy and
interfering with the satisfactory performance of duty.
n.
Hidradenitis suppurative and folliculitis decalvans.
o.
Hyperhydrosis. Of the hands or feet, when severe or complicated by a dermatitis or
infection, either fungal or bacterial, and not amenable to treatment.
p.
Leukemia cutis and mycosis fungoides.
q.
Lichen planus. Generalized and not responsive to treatment.
r.
Lupus erythematous. Chronic with extensive involvement of the skin and mucous
membranes and when the condition does not respond to treatment.
s.
Neurofibromatosis. If repulsive in appearance or when interfering with satisfactory
performance of duty.
t.
Panniculitis. Relapsing febrile, nodular.
Chapter 3. F. Page 18
COMDTINST M6000.1E
u.
Parapsoriasis. Extensive and not controlled by treatment.
v.
Pemphigus. Not responsive to treatment, and with moderate constitutional or
systemic symptoms, or interfering with satisfactory performance of duty.
w. Psoriasis. Extensive and not controllable by treatment.
x.
Radiodermatitis. If resulting in malignant degeneration at a site not amenable to
treatment.
y.
Scars and keloids. So extensive or adherent that they seriously interfere with the
function of an extremity.
z.
Scleroderma. Generalized, or of the linear type that seriously interferes with the
function of an extremity or organ.
aa. Ulcers of the skin. Not responsive to treatment after an appropriate period of time
or if interfering with satisfactory performance of duty.
bb. Urticaria. Chronic, severe, and not amenable to treatment.
cc. Xanthoma. Regardless of type, but only when interfering with the satisfactory
performance of duty.
dd. Other skin disorders. If chronic, or of a nature that requires frequent medical care
or interferes with satisfactory performance of military duty.
15. Neurological Disorders.
a.
Amyotrophic sclerosis, lateral.
b.
Atrophy, muscular, myelopathic. Includes severe residuals of poliomyelitis.
c.
Atrophy, muscular. Progressive muscular atrophy.
d.
Chorea. Chronic and progressive.
e.
Convulsive disorders. (This does not include convulsive disorders caused by, and
exclusively incident to the use of, alcohol.) Following a seizure, the member is
NFFD, and will remain unfit until he/she is controlled with medications with no
seizures for twelve months. A medical board is not required if the convulsive
disorder is well controlled.
f.
Friedreich's ataxia.
g.
Hepatolenticular degeneration.
h.
Migraine. Manifested by frequent incapacitating attacks or attacks that last for
several consecutive days and unrelieved by treatment.
Chapter 3. F. Page 19
COMDTINST M6000.1E
i.
Multiple sclerosis.
j.
Myelopathy transverse.
k.
Narcolepsy, cataplexy, and hypersomnolence.
l.
Obstructive Sleep Apnea. When not correctable by use of CPAP or surgical means.
m. Paralysis, agitans.
n.
Peripheral nerve conditions.
(1) Neuralgia. When symptoms are severe, persistent, and not responsive to
treatment.
(2) Neuritis. When manifested by more than moderate, permanent functional
impairment.
o.
Syringomyelia.
p.
General. Any other neurological condition, regardless of etiology, when after
adequate treatment, there remain residuals, such as persistent severe headaches,
convulsions not controlled by medications, weakness or paralysis of important
muscle groups, deformity, incoordination, pain or sensory disturbance, disturbance
loss of consciousness, speech or mental defects, or personality changes of such a
degree as to definitely interfere with the performance of duty.
16. Psychiatric Disorders. (See Chapter 5 Section B of this manual concerning disposition.)
a.
Disorders with Psychotic Features. Recurrent psychotic episodes, existing
symptoms or residuals thereof, or recent history of psychotic reaction sufficient to
interfere with performance of duty or with social adjustment.
b.
Affective disorders; anxiety, post-traumatic stress disorder or somatoform
disorders. Persistence or recurrence of symptoms sufficient to require treatment
(medication, counseling, psychological or psychiatric therapy) for greater than
twelve (12) months. Prophylactic treatment associated with significant medication
side effects such as sedation, dizziness, or cognitive changes or requiring frequent
follow-up that limit duty options is disqualifying. Prophylactic treatment with
medication may continue indefinitely as long as the member remains asymptomatic
following initial therapy. Any member requiring medication for any of the above
disorders must be removed from aviation duty. (Incapacity of motivation or
underlying personality traits or disorders will be processed administratively. See
Personnel Manual, COMDTINST M1000.6 (series) for further guidance.)
c.
Mood disorders. Bipolar disorders or recurrent major depression do not require the
six (6) month evaluation period prior to initiating a medical board. All other mood
disorders associated with suicide attempt, untreated substance abuse, requiring
hospitalization, or requiring treatment (including medication, counseling,
psychological or psychiatric therapy) for more than twelve (12) months.
Chapter 3. F. Page 20
COMDTINST M6000.1E
Prophylactic treatment associated with significant side effects such as sedation,
dizziness, or cognitive changes, or frequent follow-up that limit duty options is
disqualifying. Prophylactic treatment with medication(s) may continue indefinitely
as long as the member remains asymptomatic following initial therapy. Any
member requiring medication for any of the above disorders must be removed from
aviation duty. (Incapacity of motivation or underlying personality traits or
disorders will be processed administratively. See Personnel Manual,
COMDTINST M1000.6 (series) for further guidance.)
d.
Personality; sexual; factitious; psychoactive substance use disorders; personality
trait(s); disorders of impulse control not elsewhere classified. These conditions
may render an individual administratively unfit rather than unfit because of a
physical impairment. Interference with performance of effective duty will be dealt
with through appropriate administrative channels (see Chapter 5 Section B).
e.
Adjustment Disorders. Transient, situational maladjustment due to acute or special
stress does not render an individual unfit because of physical impairment.
However, if these conditions are recurrent and interfere with military duty, are not
amenable to treatment, or require prolonged treatment, administrative separation
should be recommended (see Chapter 5 Section B).
f.
Disorders usually evident in infancy, childhood, or adolescence, disorders of
intelligence. These disorders, to include developmental disorders, may render an
individual administratively unfit rather than unfit because of a physical impairment.
Anorexia Nervosa and Bulimia are processed through PDES, while the remaining
are handled administratively, if the condition significantly impacts, or has the
potential to significantly impact performance of duties (health, mission, and/or
safety). Use of non-controlled medications such as Atomoxetine or Buproprion to
treat, control, or improve performance for individuals diagnosed with Attention
Deficit Disorder (either ADD or ADHD) may be allowed in individuals when a
good prognosis is present. Individuals with Attention Deficit Disorder that
significantly impacts performance despite treatment, or if treatment is refused or
due to non-compliance, have a disqualifying condition and are processed
administratively as per Chapter 12 of the CG Personnel Manual, COMDTINST
M1000.6 (series).
17. Dental. Diseases and abnormalities of the jaws or associated tissues when, following
restorative surgery, there remain residual conditions that are incapacitating or interfere
with the individual's satisfactory performance of military duty, or deformities that are
disfiguring. Personnel must be in a Class 1 or Class 2 (see 4.C.3.c.(3)) dental status to
execute sea duty or overseas duty orders. Prior service personnel must meet the
enlistment dental standards contained in section 3-D.
18. Blood and Blood-Forming Tissue Diseases. When response to therapy is
unsatisfactory, or when therapy requires prolonged, intensive medical supervision.
a.
Anemia.
b.
Hemolytic disease, chronic and symptomatic.
Chapter 3. F. Page 21
COMDTINST M6000.1E
c.
Leukemia, chronic.
d.
Polycythemia.
e.
Purpura and other bleeding diseases. Any condition requiring long-term coumadin.
f.
Thromboembolic disease.
g.
Splenomegaly, chronic.
19. Systemic Diseases, General Defects, and Miscellaneous Conditions.
a.
Systemic Diseases.
(1) Blastomycosis.
(2) Brucellosis. Chronic with substantiated recurring febrile episodes, severe
fatigability, lassitude, depression, or general malaise.
(3) Leprosy. Any type.
(4) Myasthenia gravis.
(5) Porphyria Cutanea Tarda.
(6) Sarcoidosis. Progressive, with severe or multiple organ involvement and not
responsive to therapy.
(7) Tuberculosis (TB).
(a) Meningitis, tuberculosis.
(b) Pulmonary TB, tuberculous empyema, and tuberculous pleurisy.
(c) TB of the male genitalia. Involvement of the prostate or seminal vesicles
and other instances not corrected by surgical excision, or when residuals
are more than minimal, or are symptomatic.
(d) TB of the female genitalia.
(e) TB of the kidney.
(f) TB of the larynx.
(g) TB of the lymph nodes, skin, bone, joints, eyes, intestines, and peritoneum
or mesentery will be evaluated on an individual basis considering the
associated involvement, residuals, and complications.
(8) Symptomatic neurosyphilis. In any form.
b.
General Defects.
(1) Visceral, abdominal, or cerebral allergy. Severe or not responsive to therapy.
Chapter 3. F. Page 22
COMDTINST M6000.1E
(2) Cold injury. Evaluate on severity and extent of residuals, or loss of parts as
outlined in section 3-F-12.
c.
Miscellaneous Conditions or circumstances.
(1) Chronic Fatigue Syndrome, Fibromyalgia , and Myofascial Syndrome when
not controlled by medication or with reliably diagnosed depression.
(2) The individual is precluded from a reasonable fulfillment of the purpose of
employment in the military service.
(3) The individual's health or well-being would be compromised if allowed to
remain in the military service.
(4) The individual's retention in the military service would prejudice the best
interests of the Government.
(5) Required chronic and continuous DEA controlled (Class I-V) medications,
such as Ritalin, Amphetamine, Cylert, Modafanil.
(6) Required chronic anti-coagulant, other than aspirin, such as Coumadin.
(7) Chronic (greater than 30 days per year) use of immunosuppressive medications
including steroids.
20. Tumors and Malignant Diseases.
a.
Malignant Neoplasms. If they are unresponsive to therapy or when the residuals of
treatment are in themselves disqualifying under other provisions of this section or
in individuals on active duty when they preclude satisfactory performance of duty.
b.
Neoplastic Conditions of Lymphoid and Blood Forming Tissues. Render an
individual unfit for further military service.
c.
Benign Neoplasms. Except as noted below, benign neoplasms are not generally a
cause of unfitness because they are usually remediable. Individuals who refuse
treatment are unfit only if their condition precludes satisfactory performance of
military duty. However, the following normally render the individual unfit for
further military service:
(1) Ganglioneuroma.
(2) Meningeal fibroblastoma. When the brain is involved.
21. Sexually Transmitted Infection. Complications or residuals of such chronicity or
degree of severity that the individual is incapable of performing useful duty.
22. Human Immunodeficiency Virus (HIV). CG personnel who demonstrate no evidence
of unfitting conditions of immunologic deficiency, neurologic deficiency, and
progressive clinical or laboratory abnormalities associated with HIV or AIDS-defining
condition shall be retained in the service unless some other reason for separation exists.
Military personnel who are HIV antibody positive and retained shall not be assigned to
Chapter 3. F. Page 23
COMDTINST M6000.1E
deployable billets (e.g. cutters, Patrol Force South West Asia, Deployable Operations
Group units), or small boat stations or outside the continental United States.
COMDTINST M6230.9, Coast Guard Human Immunodeficiency Virus (HIV) Program
provides detailed guidance on identification, surveillance and administration of CG
personnel infected with HIV.
23. Transplant recipient. Any organ or tissue except hair or skin.
Chapter 3. F. Page 24
COMDTINST M6000.1E
Chapter 3. F. Page 25
COMDTINST M6000.1E
Chapter 3. F. Page 26
COMDTINST M6000.1E
Section G. Physical Standards for Aviation
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Classification of Aviation Personnel. ..................................................................................1
General Instructions for Aviation Examinations. ................................................................1
Restrictions Until Physically Qualified. ..............................................................................4
Standards for Class l. ...........................................................................................................4
Candidates for Flight Training. ............................................................................................7
Requirements for Class 2 Aircrew. ....................................................................................10
Requirements for Class 2 Medical Personnel. ...................................................................10
Requirements for Class 2 Technical Observers. ................................................................11
Requirements for Class 2 Air Traffic Controllers..............................................................11
Requirements for Landing Signal Officer (LSO). .............................................................11
Refractive Surgery. ............................................................................................................12
Contact Lenses. ..................................................................................................................13
Chapter 3. G. Page i
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Chapter 3. G. Page ii
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G. Physical Standards for Aviation.
1.
Classification of Aviation Personnel.
a. Aviation Personnel in General. Classification of CG aviation personnel is
similar to that prescribed for Navy aviation personnel. The term "aviation
personnel" includes all individuals who, in the performance of their duty,
are required to make frequent aerial flights. Aviation personnel are divided
into two classes: Class 1 and Class 2.
b. Class 1. Class 1 consists of aviation personnel engaged in actual control of
aircraft, which includes aviators, student aviators, and student Flight
Surgeons that are chosen to perform solo flights.
c. Changing Classes. Except for changes in class due solely to age, individuals
requiring a change in their classification for more than two months must
submit the following to Commander PSC:
(1) Medical Record, SF-507 completed by a Flight Surgeon/Aviation
Medical Officer stating the need for the class change and whether a
permanent or temporary change is requested; and
(2) Command endorsement.
d. Class 2. Class 2 consists of aviation personnel not engaged in actual control
of aircraft. This includes aviation observers, technical observers, Flight
Surgeons, Aviation Medical Officers, Aviation Mission Specialists, aircrew
members, Air Traffic Controllers, and other persons ordered to duty
involving flying.
2.
General Instructions for Aviation Examinations.
a.
Object of Aviation Physical Examinations.
(1) The examination for flying shall be limited to members of the
aeronautical organization and authorized candidates. The object of an
aviation physical examination is to ensure individuals involved in
aviation are physically and mentally qualified for such duty, and to
remove from aviation those who are temporarily or permanently unfit
because of physical or mental defect.
(2) The main objective in examining candidates for flight training is
selecting individuals who can fly safely and continue to do so for at
least 20 years.
(3) For designated aviators, the objective is to determine if the individual
can fly safely during the next 24 months.
Chapter 3. G. Page 1
COMDTINST M6000.1E
b.
Performance of Aviation Physical Examinations. To promote safety and to
provide uniformity and completeness, an aviation physical examination
must be performed by a currently qualified Flight Surgeon (FS), Flight
Surgeon Trainee (FST), Aviation Medical Officer (AMO), or Aeromedical
Physician Assistant (APA) authorized by the Commandant or currently
serving in the DOD. Only physicians or physician assistants who have
successfully passed a course at a school of aviation medicine of the U. S.
Armed Forces leading to the designation of “Flight Surgeon”, “Aviation
Medical Officer” or “Aeromedical Physician Assistant” are so authorized.
Civilian physicians who were military Flight Surgeons and who are
currently certified by the Federal Aviation Administration as aviation
medical examiners may also be authorized. Flight physicals performed by a
DOD Flight Surgeon and approved through Army or Navy channels will be
accepted as an approved flight physical.
c.
Scope of Aviation Physical Examination. In addition to the general service
requirements specified in section 3-D, certain special requirements must be
met by the various categories of individuals concerned with aviation. The
extent of the examination and the physical standards vary for the several
categories of aviation personnel. The term "flight or aviation physical
examination" is therefore incomplete unless the character of the duty that
the examinee is to perform is specified--this incomplete term shall not be
used in item #16 of Report of Medical Examination, DD-2808 as the
purpose of the examination. Examiners shall conduct aviation physical
examinations in accordance with the general procedures specified in this
section and in section 3-C.
d.
Required Aviation Physical Examinations. Each individual in the Service
who is assigned to duty requiring performance of frequent aerial flights,
regardless of classification, must have passed an aviation physical within
the preceding 24 months. In some cases, more frequent examinations are
required. Aviation physical examinations are required as indicated in this
section. They may also be ordered whenever needed to determine an
individual's physical fitness for the type aviation duty to which assigned.
(1) Entry on Active Duty. Reserve aviation personnel who perform
frequent aerial flights must have passed an aviation physical
examination, commensurate with the type of duty to be performed,
within the 24 months preceding active duty or active duty for training.
Aviators who are not members of aviation reserve units must have
satisfactorily passed an aviation physical examination within six
months immediately preceding the actual control of aircraft.
(2) Biennial. All aviation personnel, including Reservists on inactive duty
for training, who will actually control aircraft or perform frequent aerial
flights must obtain a biennial aviation physical examination
commensurate with the type of duty to be performed. The examination
Chapter 3. G. Page 2
COMDTINST M6000.1E
is required every two (2) years after initial designation. Upon reaching
age 50, the examinations become annual.
(3) Direct Commission. An aviation physical examination is required prior
to direct commissioning of aviators in the Reserve. The aviator is
required to meet Class I standards.
(4) Candidates for Designation as Class 1. All candidates for flight
training, whether or not they are already in the Service, must pass a
physical examination for flight training duty. The examination date
must not precede the application date by more than 12 months.
(5) Candidates for Designation as Class 2. An approved aviation physical
examination less than 24 months old is required both when applying for
a Class 2 aviation training program and prior to a Class 2 designation.
(6) FAA Airmen Medical Certificate. After receiving Federal Aviation
Administration (FAA) Aviation Medical Examiner (AME) training, CG
Flight Surgeons/AMOs may request authorization from Commandant
(CG-1121) to perform Second and Third Class physical examinations
and issue FAA Medical Certificates to all military personnel on active
duty including active duty for training. The FAA Administrator
furnishes AME's with the necessary instructions, guides, and forms
required for this purpose. Except in those instances where there is a
military requirement for FAA certification, examination and issuance
of medical certificates shall not interfere with the Flight Surgeon's
primary duties. Whenever possible, certificates should be obtained in
conjunction with a required aviation physical examination.
(7) Aircraft Accidents. Any CG member involved in a Class A or B
aircraft mishap in which damage to the aircraft or injury to any
crewmember occurs shall undergo a complete aviation physical
examination as part of the mishap investigation. Examinations after
other mishaps are left to the discretion of the Flight Surgeon/AMO.
(8) Quinquennial. The quinquennial examination of a Reserve aviation
special duty officer must be an aviation physical examination.
(9) Separation. An aviation physical examination is not required of
aviation personnel being separated from active duty. The requirements
for examination are the same as those for the separation from active
duty of non-aviation personnel.
e.
Boards. Assignment to and continuation of duty involving flying is an
administrative process. Except for enlisted personnel in aviation ratings,
fitness to perform aviation duties is a determination independent of the
determination of fitness for continued service. The process regarding
Chapter 3. G. Page 3
COMDTINST M6000.1E
physical disqualifications and waivers for aviation personnel is outlined in
the Coast Guard Aviation Medicine Manual, COMDTINST 6410.3 (series).
f.
Reporting Fitness for Flying Duties. The process for reporting fitness for
duty for aviation personnel is outlined in the Coast Guard Aviation
Medicine Manual, COMDTINST 6410.3.
g.
Reporting Aviation Physical Examinations. The process for reporting
aviation physical examinations for aviation personnel is outlined in the CG
Aviation Medicine Manual, COMDTINST 6410.3.
3.
Restrictions Until Physically Qualified. The process regarding restrictions until
physically qualified for aviation personnel is outlined in the CG Aviation
Medicine Manual, COMDTINST 6410.3 (series).
4.
Standards for Class l.
a. General. The physical examination and physical standards for Class 1 are
the same as those prescribed in sections 3-C and 3-D of this Manual, as
modified by the following subparagraphs.
b. History.
(1) History of any of the following is disqualifying: seizures, isolated or
repetitive (grand mal, petit mal, psychomotor, or Jacksonian); head
injury complicated by unconsciousness in excess of 12 hours or post
traumatic amnesia or impaired judgment exceeding 48 hours; malaria,
until adequate therapy has been completed and there are no symptoms
while off all medication for 3 months.
(2) For persons already in the CG a complete review of their health record
is most important. Flight Surgeons are authorized to postpone the
examination of persons who fail to present their health record at the
time of examination. In exercising this prerogative, due consideration
must be made in cases where access to the individual's health record is
administratively impracticable.
c. Therapeutics and General Fitness. Note on the Report of Medical
Examination, DD-2808 if the individual received medication or other
therapeutic procedures within 24 hours of the examination. In general,
individuals requiring therapeutics or who have observed lowering of general
fitness (dietary, rest, emotional, etc.,) which might affect their flying
proficiency shall not be found qualified for duty involving flying.
d. Each aviation physical will have a Valsalva, and AA (Aeronautical
Adaptability) performed and noted.
e. Height. Minimum 157.4 cm (62 inches). Maximum 198 cm (78 inches).
Chapter 3. G. Page 4
COMDTINST M6000.1E
f.
Chest. Any condition that serves to impair respiratory function may be
cause for rejection. Pulmonary function tests are recommended to evaluate
individuals with a history of significant respiratory system problems.
g. Skin. Psoriasis unless mild by degree, not involving nail-pitting and not
interfering with the wearing of military equipment or clothing.
h. Cardiovascular System.
(1) Cardiac arrhythmia, heart murmur, or other evidence of cardiovascular
abnormalities shall be carefully studied. Evidence of organic heart
disease, rhythm disturbances or vascular diseases, if considered to
impair the performance of flying duties, is cause for rejection.
(2) Sinus Bradycardia. Extreme sinus bradycardia may be a reflection of
an underlying conduction system abnormality. There may be an
inability to increase the heart rate in response to increased demand.
(a) Waiver: If the heart rate increases with exercise, the bradycardia is
NCD, and no waiver is required.
1. If the resting HR is less than 50, supply a current EKG
demonstrating a sinus rhythm without evidence of prolonged
QT, pre-excitation (ie WPW etc) cardiac hypertrophy, heart
block, or ischemic changes. Any such changes require further
work up.
2. Provide a rhythm strip demonstrating a rise of at least 10 bpm
from baseline with exercise in less than 2 minutes.
(b) Treatment: No treatment is indicated if the rate increases with
exercise; the condition is NCD.
(c) Discussion: A resting HR<50 bpm in our population is almost
usually caused by excellent physical conditioning.
i.
Teeth. The following are disqualifying:
(1) Any carious teeth that would react adversely to sudden changes in
barometric pressure or produce indistinct speech by direct voice or
radio transmission.
(2) Any dental defect that would react adversely to sudden changes in
barometric pressure or produce indistinct speech by direct voice or
radio transmission.
(3) Fixed active orthodontic appliances require a waiver from PSC (opm or
epm). Fixed retainers are exempts.
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COMDTINST M6000.1E
(4) Routine crown and temporary dental work is not disqualifying for
aviation missions. Recommend that temporary crowns be cemented
with permanent cement like polycarboxylate or zinc oxyphosphate
cement until the permanent crown is delivered. Recommend temporary
grounding of 6-12 hours after procedures. Such work may be
disqualifying for deployment.
j.
Distant Visual Acuity. Distant visual acuity shall be not less than 20/200 in
either eye and if less than 20/20 must be correctable to 20/20 with standard
lenses. When the visual acuity of either eye is less than 20/20 correction
shall be worn at all times while flying.
k. Oculomotor Balance. The following are disqualifying:
(1) Esophoria greater than 10 prism diopters.
(2) Exophoria greater than 10 prism diopters.
(3) Hyperphoria greater than 1.5 prism diopters.
(4) Prism divergence at 20 feet and 13 inches is optional. These tests shall
be accomplished only on designated aviators who have sustained
significant head injury, central nervous system disease, or who have
demonstrated a change in their phorias.
l.
Eyes. Any pathologic condition that may become worse or interfere with
proper eye function under the environmental and operational conditions of
flying disqualifies. History of radial keratotomy is disqualifying.
Intraocular pressures shall be tested and reported with each periodic exam.
m. Near Visual Acuity. Uncorrected near vision (both eyes) shall be not less
than 20/200 correctable to 20/20, with correction worn in multivision lenses
while flying if uncorrected near vision is less than 20/40 in either eye.
n. Color Vision. Normal color perception is required. The testing for color
vision must be unaided or with standard corrective lenses only. Use of any
lenses (such as Chromagen) or other device to compensate for defective
color vision is prohibited. See Chapter 3 Section C. 22. i. for details on how
to perform the test.
o. Depth Perception. Normal depth perception is required. When any
correction is required for normal depth perception it must be worn at all
times. See Chapter 3 Section C. 22. j. for details on how to perform the test.
p. Field of Vision. The field of vision for each eye shall be normal as
determined by the finger fixation test. When there is evidence of abnormal
contraction of the field of vision in either eye, the examinee shall be
subjected to perimetric study for form. Any contraction of the form field of
15 degrees or more in any meridian is disqualifying.
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COMDTINST M6000.1E
q. Refraction. There are no refractive limits.
5.
r.
Ophthalmoscopic Examination. Any abnormality disclosed on
ophthalmoscopic examination that materially interferes with normal ocular
function is disqualifying. Other abnormal disclosures indicative of disease,
other than those directly affecting the eyes, shall be considered with regard
to the importance of those conditions.
s.
Ear. The examination shall relate primarily to equilibrium and the patency
of eustachian tubes. A perforation or evidence of present inflammation is
disqualifying. The presence of a small scar with no hearing deficiency and
no evidence of inflammation does not disqualify. Perforation, or marked
retraction of a drum membrane associated with chronic ear disease, is
disqualifying.
t.
Sickle Cell Preparation Test. Quantitative hemoglobin electrophoreses
greater than 40% Hemoglobin-s is disqualifying because of the risk of
hypoxia induced red blood cell deformation in the aviation environment.
Candidates for Flight Training.
a.
Standards. Candidates for flight training shall meet all the requirements of
Class 1, with the following additions or limitations:
(1) Cardiovascular.
(a) Candidates with accessory conduction pathways (Wolff-ParkinsonWhite (WPW), other ventricular pre-excitation patterns) are CD.
No waiver is recommended for candidates with this condition.
(b) Candidates with WPW Syndrome who have had definitive
treatment via Radio Frequency (RF) ablation with demonstrable
non-conduction on follow-up Electrophysiologic Studies (EPS) are
considered for waiver on a case-by-case basis.
(c) Asymptomatic candidates: When incidentally noted accessory
bypass tracts, proven incapable of sustained rapid conduction as
demonstrated by EPS, is discovered in a candidate, the candidate
(if asymptomatic), will be considered qualified. In general, EPS is
not recommended in asymptomatic individuals.
(2) Height. Candidates for Class I training must also satisfy the following
anthropometric requirements: Refer to figure 3-G-1 through figure 3G-4 for guidelines on measurements.
(a) Sitting height: 33 inches to 40.9 inches. Record in parentheses in
Item 73, Report of Medical Examination, DD-2808 (SH_____),
see figure 3-G-1 for proper measurements.
Chapter 3. G. Page 7
COMDTINST M6000.1E
(b) Sitting eye height: 28.5 inches or greater. Record in parentheses
in Item 73, Report of Medical Examination, DD-2808
(SEH_____), see figure 3-G-2 for proper measurements.
(c) Thumb tip reach: 28.5 inches or greater. Record in parentheses in
Item 73, Report of Medical Examination, DD-2808 (TTR____),
see figure 3-G-3 for proper measurements.
(d) Buttock-knee length: 21 inches to 27.9 inches. Record in
parentheses in Item 73, Report of Medical Examination, DD-2808
(BKL____), see figure 3-G-3 for proper measurements.
(e) Add: sitting eye height (SEH) and thumb tip reach (TTR), 57
inches or greater. Record in parentheses in Item 73, Report of
Medical Examination, DD-2808 (SEH + TTR =____).
(3) Vision.
(a) Uncorrected distant visual acuity must be not less than 20/50 each
eye and correctable 20/20 each eye. Uncorrected near visual
acuity must be not less than 20/20 each eye (may be waiverable).
(b) While under the effects of a cycloplegic, the candidate must read
20/20 each eye. The following are disqualifying:
1. Total myopia greater than (minus) -2.00 diopters in any
meridian.
2. Total hyperopia greater than (plus) +3.00 diopters in any
meridian.
3. Astigmatism greater than (minus) -0.75 diopters. (Report the
astigmatic correction in terms of the negative cylinder
required.)
4. The purpose of this cycloplegic examination is to detect large
latent refractive errors that could result in a change of classes
during an aviation career. Therefore, the maximum correction
tolerated at an acuity of 20/20 shall be reported. Cycloplegics
reported as any other acuity, e.g., 20/15 will be returned.
(c) Refractive Surgery: The CG will consider sending candidates to
Navy Flight School who have had photorefractive keratectomy,
(anterior corneal stromal surface laser ablation), and meet all of the
enrollment criteria. Refractive surgery may be done by a DOD or
a civilian provider. (This is an elective procedure. Guidelines for
elective procedures are outlined in Chapter 2 Section A 6. of this
manual.) Candidates must have demonstrated refractive stability
Chapter 3. G. Page 8
COMDTINST M6000.1E
as confirmed by clinical records. Neither the spherical or
cylindrical portion of the refraction may have changed more than
0.50 diopters during the two most recent postoperative manifest
refractions separated by at least one month. The final manifest
shall be performed no sooner than the end of the minimum waiting
period (3 or 6 months depending on the degree of preoperative
refractive error). The member must have postoperative
uncorrected visual acuity of at least 20/50 correctable with
spectacles to at least 20/20 for near and distance vision. Detailed
enrollment criteria may be obtained by contacting PSC-opm-2.
(4) Hearing. Audiometric loss in excess of the limits set forth in the
following table is disqualifying:
FREQUENCY
EITHER EAR
500
30
1000
25
2000
25
3000
45
4000
55
(5) Personality. Must demonstrate, in an interview with the Flight
Surgeon, a personality make-up of such traits and reaction that will
indicate that the candidate will successfully survive the rigors of the
flight training program and give satisfactory performance under the
stress of flying.
(6) Chest x-ray. Aviation trainees must have had a chest x-ray within the
past three years.
(7) Report of Medical History, DD-2807-1. In addition to the normal
completion of the Report of Medical History, DD-2807-1, the
following statement shall be typed in block 29 and signed by the
applicant: "I certify that I do not now use, nor have I ever used, contact
lens for any purpose, and that I am not aware that my uncorrected
vision has ever been less than 20/50." If the applicant cannot sign this
statement, include a full explanation by the examining Flight Surgeon,
and an ophthalmology consultation.
b.
Reporting.
(1) The importance of the physical examination of a candidate should be
recognized not only by the examining Flight Surgeon but also by health
services personnel assisting in the procedure and preparing the report.
Candidates often come from a great distance or from isolated ships. If
the examination cannot be completed in one working day, seek the
Commanding Officer's help in making it possible for the candidate to
remain available for a second working day. Careful planning should
keep such cases to a minimum. If a report, upon reaching Commandant
(CG-112), is found to be incomplete and must be returned, the
candidate will suffer undue delay in receiving orders and in some cases
Chapter 3. G. Page 9
COMDTINST M6000.1E
will be completely lost to the CG as a candidate. The preparation of the
Report of Medical Examination, DD-2808 in the case of a candidate
requires extreme care by all concerned.
(2) In a report of the examination of a candidate, rigid adherence to set
standards is expected. The examining officers are encouraged to use
freely that portion of the report that provides for "remarks" or "notes."
Comments made under "remarks" are the examiner's opinion.
Information from any source may be molded into an expression of
professional opinion. A final recommendation of the examiner must be
made. When such recommendation is not consistent with standards set
by Commandant (CG-11) the examiner shall note that fact on the form
under "remarks" or "notes" and a reasonable explanation made. When
space on a Report of Medical Examination, DD-2808 is inadequate, use
a Medical Record, SF-507.
6.
Requirements for Class 2 Aircrew.
a. Aircrew Candidates. Unless otherwise directed by Commander PSC (epm),
personnel will not be permitted to undergo training leading to the
designation of aircrewmen unless a Flight Surgeon/aviation Medical Officer
has found them physically qualified for such training. Should it be
desirable, for exceptional reasons, to place in training a candidate who does
not meet the prescribed physical standards, the Commanding Officer may
submit a request for a waiver, with the Report of Medical Examination,
DD-2808 and Report of Medial History, DD-2807-1, to Commander PSC,
justifying the request. Aircrew candidates shall meet the standards for
Class 1, except that minimum height is 152.5 cm/60 inches and uncorrected
distant visual acuity must be not less than 20/100 each eye, correctable to
20/20 each eye. Cycloplegic refraction and anthropometric measurements
are not indicated. A chest x-ray is required within the previous 3 years.
b. Designated Aircrew. Aircrew shall meet the standards for Class 1, except
the minimum height is 152.5 cm/60 inches.
7.
Requirements for Class 2 Medical Personnel.
a.
Flight Surgeon (FS)/Aviation Medical Officer (AMO)/Aeromedical
Physician Assistants (APA), FS Candidates. While assigned to a Duty
Involving Flight Operations billet, FS/AMOs/APAs shall meet the standards
for Class II Aircrew, except that minimum height is 152.5 cm (60 inches).
b.
Aviation Mission Specialists (AMS)/AMS Candidates. Aviation Mission
Specialists (Health Services Technicians (HS) who are assigned to flight
orders), shall meet the standards for Class II Aircrew, except that minimum
height is 152.5 cm (60 inches).
Chapter 3. G. Page 10
COMDTINST M6000.1E
8.
Requirements for Class 2 Technical Observers. The term "technical observer" is
applied to personnel who do not possess an aviation designation but who are
detailed to duty involving flying. The examination shall relate primarily to
equilibrium and the patency of eustachian tubes. They shall meet the standards
prescribed for general duty. These personnel are not required to undergo a
physical examination for flying provided a complete physical examination, for
any purpose, has been passed within the preceding 60 months and intervening
medical history is not significant. The physical examination need not be
conducted by an FS/AMO. Technical observers who are required to undergo
egress training must have a current (general purpose) physical examination and
a status profile chit indicating "OK DIF/Dunker/Chamber."
9.
Requirements for Class 2 Air Traffic Controllers. Air traffic controllers, tower
controllers, and ground control approach operators shall meet the general
physical standards for Class 1, except:
a.
Articulation. Must speak clearly and distinctly without accent or
impediment of speech that would interfere with radio communication.
Voice must be well modulated and pitched in medium range. Stammering,
poor diction, or other evidence of speech impediments that become manifest
or aggravated under excitement are disqualifying.
b.
Height. Same as general service.
c.
Visual Acuity.
(1) Candidate's visual acuity shall be no worse than 20/100 for each eye
correctable to 20/20 each eye and the correction shall be worn while on
duty.
(2) Personnel already designated shall have distant visual acuity no worse
than 20/200 each eye correctable to 20/20 each eye and the correction
shall be worn while on duty.
(3) Air Traffic Controllers whose vision becomes worse than 20/200 either
eye may not engage in the control of air traffic in a control tower but
may be otherwise employed in the duties of their rating.
d.
Depth Perception. Normal depth perception is required.
e.
Heterophoria. The following are disqualifying:
(1) esophoria or exophoria greater than 6 prism diopters; and
(2) hyperphoria greater than 1 prism diopter.
10. Requirements for Landing Signal Officer (LSO).
a.
Physical Examinations for Landing Signal Officer (LSO).
(1) Candidates. Officer and enlisted candidates for training as LSO's shall
have a physical examination prior to the training leading to
Chapter 3. G. Page 11
COMDTINST M6000.1E
qualification. LSO duties for flight deck require stricter visual acuity
standards than those for general duty in the CG. Examination by a
FS/AMO is not required.
(2) Reexamination. Biennial reexamination is required of all currently
qualified LSO's.
b.
Physical Standards for LSO's. In addition to the physical standards required
for officer and enlisted personnel, the following standards apply:
(1) Distant Visual Acuity. The uncorrected distant visual acuity shall be
no worse than 20/200 in each eye and must be correctable to 20/20 in
each eye. If the uncorrected distant visual acuity is less than 20/20 in
either eye, corrective lenses must be worn while performing LSO
duties.
(2) Depth Perception. Normal depth perception is required.
(3) Color Vision. Normal color perception is required.
11. Refractive Surgery. All Classes: Certain Corneal refractive surgery can be
waived for all classes. NOTE: Class 1 can only undergo refractive surgery
while serving in a non-flying status. Only PRK and variants of custom wave
form, LASEK and epi-LASIK are approved. Procedures with a corneal stromal
flap will be considered for aviation personnel on a case by case basis. Other
corneal refractive surgery, rings or implants are disqualifying and will not be
considered. The PRK procedure, which is approved, must be performed at a
MTF for all aviation classes. (Exception: see Chap 3.Section G. 5. a(3)(c) for
SNA candidate requirements)
a.
All pre-operative, operative and post operative medical records must be
submitted for review by the waiver authority.
b.
Preoperative refractive limits: Sphere: -8.00 to +6.00 diopters. Cylinder:
-3.00 to +3.00 diopters. Anisometropia: 3.5 diopters.
c.
Post-operative refractive stability. Demonstration of post-operative
refractive stability shall be demonstrated by 2 consecutive manifest
refractions, obtained at least 30 days apart. For those with a pre-operative
refraction of plano to -5.50 diopters of sphere the initial post operative
refraction should be no sooner than 30 days after the surgery. A follow up
refraction shall be done no sooner than 30 days after the initial post
refraction. For those with a pre-operative refraction of -5.75 to -8.00
diopters of sphere or +0.25 to +6.00 diopters of sphere, the earliest manifest
refraction is at 6 months post-op.
d.
Refractive stability. If refractive stability is demonstrated as evidenced by
less than a 0.50 diopters change over two separate exams at least four weeks
apart, then the member can apply to PSC for a waiver 3 months after
Chapter 3. G. Page 12
COMDTINST M6000.1E
surgery. The post-operative manifest refractions can vary by no more than
0.50 diopters. Waiver consideration will not be made until this is achieved.
e.
Quality of vision questionnaire. The member must not have any visual
complaints post operatively per the quality of vision questionnaire which is
to be included in the waiver package. This form can be found on the
following Commandant (CG-112) Web Site:
http://www.uscg.mil/hq/cg1/cg11/.
f.
Post operative standards. Post operatively the member must meet all
aviation visual standards in this section. (Member must have 20/20 vision
or vision correctable to 20/20 in both eyes)
g.
Submission of a waiver request and follow up will be IAW applicable
message or COMDTINST. All required follow up exams will be
accomplished on time and be within guidelines or conditions of the waiver
will be deemed not met and the member will be grounded and required to
re-submit the waiver request.
h.
A quality of vision questionnaire and visual acuity check is to be done every
three months for one year after the surgery. This information is to be noted
in the member’s medical record and reviewed by the Flight Surgeon.
12. Contact Lenses.
a.
Class 1 personnel may be authorized by their local Flight Surgeon to wear
contact lenses while flying, provided the following conditions are met:
(1) Only gas permeable disposable soft lenses may be used.
(2) The lenses are to be removed during the hours of sleep.
(3) The lenses are disposed of after 2 weeks of use.
(4) All prescribed optometry follow-up visits are adhered to. After routine
safe use has been established and documented by the prescribing
optometric authority, an annual optometric recheck is the minimum
required. A copy of the record of any visit to an eye care professional
will be furnished by the member to the local Flight Surgeon for review
and placement in the member's health record.
(5) Following any change in the refractive power of the contact lens, the
member must be checked on the AFVT to ensure that CG Class I
standards for acuity and depth perception are met. In addition, the
Flight Surgeon shall document that there is no lens displacement, when
user moves his/her eyes through all 8 extreme ranges of gaze.
Chapter 3. G. Page 13
COMDTINST M6000.1E
(6) Contact lens case, saline for eye use, and an appropriate pair of
eyeglasses are readily accessible (within reach) to the lens wearer while
in-flight.
(7) Contact lens candidate submits request to the command agreeing to
abide the above conditions.
(8) The Flight Surgeon authorizes use of contact lenses after ensuring that
such use is safe and the user fully understands the conditions of use.
This authorization expires after one year. Initial and any annual reauthorizations shall be documented by an entry in the health record.
(9) Contact lens use is not a requirement for aviation operations. The
decision to apply for authorization is an individual option.
Accordingly, lens procurement and routine optometric care related to
contact lens use at government expense are not authorized.
b.
The optional wearing of contact lenses by Class 2 personnel performing
duty involving flying and by air control personnel in the actual performance
of their duties is authorized under the following circumstances:
(1) Individuals are fully acclimated to wearing contact lenses and visual
acuity is fully corrected by such lenses;
(2) Individuals wearing contact lenses while performing flight or air
control duties have on their person, at all times, an appropriate pair of
spectacles;
(3) A Flight Surgeon has specifically authorized the wearing of contact
lenses while performing flight or air control duties (An entry shall be
made on a Chronological Record of Care, SF-600 in the individual's
health record authorizing wearing of contact lenses.); and
(4) Wearing contact lenses while performing aviation duties is an
individual option. Accordingly, procuring contact lenses at
government expense is not authorized.
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COMDTINST M6000.1E
Sitting Height
Purpose
This measurement is important in the design and layout of work stations occupied by Navy personnel. Controls
must be placed in numerous locations, and the minimum acceptable space between the helmet and the canopy of
cockpits must be considered.
Equipment Required
Anthropometer
Measurement Procedure
1.
The subject sits erect facing forward with the head level (see
illustration below), the shoulders and upper arms relaxed, and
the forearms and hands extended forward horizontally with the
palms facing each other. The thighs are parallel, and the knees
are flexed 90° with the feet in line with the thighs.
2.
Measure the vertical distance between the sitting surface and
the top of the head with an anthropometer. The shoulders and
upper extremities should be relaxed. Measure at the maximum
point of quiet respiration.
NOTE: Measurements are to be taken to the nearest eighth of an inch. The measurement should be taken at least twice. If
there is a large variation between the two measurements, recheck the body position and repeat measurements.
Chapter 3. G. Page 15
COMDTINST M6000.1E
Eye Height, Sitting
Purpose
Sitting Eye Height plays a decisive role in instrument panel layout, viewing angles, and seat
adjustment, since the pilot must have optimum vision both inside and outside of the cockpit.
Equipment Required
Anthropometer
Measurement Procedure
1.
The subject sits erect facing forward with the head level (see
illustration below), the shoulders and upper arms relaxed, and
the forearms and hands extended forward horizontally with the
palms facing each other. The thighs are parallel and the knees
are flexed 90° with the feet in line with the thighs.
2.
Measure the vertical distance between the sitting surface and
the corner or angle formed by the meeting of the eyelids on the
outer corner of the right eye with an anthropometer.
NOTE: Measurements are to be taken to the nearest eighth of an inch. Measurements should be taken at least
twice. If there is a large variation between the two measurements, recheck body position and repeat
measurements.
Chapter 3. G. Page 16
COMDTINST M6000.1E
Thumbtip Reach
Purpose
This measurement is important in the design and layout of work stations occupied or used by Navy personnel.
Thumbtip reach is particularly useful for the placement of controls in various locations within cockpits.
Equipment Required
Wall--mounted linear scale.
Measurement Procedure
1.
The subject stands erect in a corner looking straight ahead
with the feet together and heels 7.87 inhes (20 cm) from the
back wall.
2.
With the buttocks and shoulder placed against the wall, the
right arm and hand (palm down) are stretched horizontally
along the scale while the thumb continues along the horizontal
line of the arm with the index finger curving around to touch
the pad at end of the thumb.
3.
The subject’s right shoulder is held against the rear wall. The
horizontal distance from the back wall to the tip of the right
thumb is measured.
NOTE 1: Measurements are to be taken to the nearest eighth of an inch. Measurements should be taken at least twice. If
there is a large variation between the two measurements, recheck body position and repeat measurements.
Chapter 3. G. Page 17
COMDTINST M6000.1E
Buttock-Knee Length
Purpose
This measurement is usually associated with ejection seat clearance and threshold values between the
knee and the glare shield (or canopy bow).
Equipment Required
Anthropometer
Measurement Procedure
1.
While the subject sits erect, draw a landmark on the
bottom tip of the right knee cap. The subject’s thighs
should be parallel, with the knees flexed at 90°. The feet
should be in line with the thighs, and lying flat on the
surface of a footrest or the floor.
2.
The anthropometer is placed flush against the buttock
plate at the most posterior point on either buttock, and
the anterior point to the right knee is measured with an
anthropometer.
Chapter 3. G. Page 18
COMDTINST M6000.1E
Section H. Physical Examinations and Standards for Diving Duty
1.
2.
Examinations............................................................................................................1
Standards. .................................................................................................................2
Chapter 3. H. Page i
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Chapter 3. H. Page ii
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H. Physical Examinations and Standards for Diving Duty. To promote safety and to
provide uniformity and completeness, a diving physical examination must be performed
by a currently qualified Dive Medical Officer (DMO). Any health care provider can
recommend to the command a limited duty status based upon medical illness or injury.
An ill or injured diver may only be returned to diving duties by a qualified DMO.
1. Examinations.
a. Candidates. Personnel whose duty exposes them to a hyperbaric environment
must conform to the physical standards for diving duty. The Physical
standards for diving duty are a combination of standards contained in section
3-D and the additional standards listed in this section. It is therefore critical
that the HCP evaluating divers and candidates for diver training be familiar
with these physical standards.
b. Dive Physical Examinations. Dive physical examinations should be
performed by a Medical Officer who has successfully completed the diving
Medical Officer (DMO) course at the Naval Diving Salvage training Center
(NDSTC). However, any credentialed CG HCP may perform a Dive Physical
but final approval can only be made by review and countersignature of a
qualified Dive Medical Officer (DMO).
c. Frequency of examination. The diving physical is performed on candidates
when applying for initial dive training. Subsequent examinations are
performed on designated divers on birth date at ages 20, 25, 30, 35, 40, 45, 50,
and annually thereafter, and in support of waiver requests when a diver’s
physical condition requires a determination of fitness for diving duty. All
members on diving duty will have an annual periodic health assessment
(PHA) to maintain diving duty qualification. This will include recommended
preventive health examinations. For divers the annual PHA will include
documentation of skin cancer screening. Additionally, all designated divers
require an audiogram every 5 years. If at anytime a significant threshold shift
is documented, follow up per OMSEP requirements outlined in Chapter 12,
section 7, of this manual will be completed. When a members hearing falls
outside the diving duty standards, a waiver is required.
d. Documentation. A dive physical will consist of a completed Report of
Medical History, DD-2807-1 and Report of Medical Examination, DD-2808.
All applicants for initial and follow-on dive training must have a valid
Diver/Buds/s Medical Screening Questionnaire, CG-6000-3 (formally known
as Exhibit 8), completed and signed no later than 30 days prior to
commencing training. This form serves as an interval medical history from
the time the original dive physical was performed up to the member’s training
date as well as a medical screening for any missed or new condition that may
be considered disqualifying. Any condition found to be disqualifying needs to
be addressed prior to the member’s transfer to dive training. The U.S.
Military Diving Medical Screening Questionnaire should be added to the
member’s medical record.
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COMDTINST M6000.1E
e. Waivers. Waivers for initial application or continuance of duty may be
requested if a disqualifying condition exists. The request is routed from the
examining HCP to HSWL SC then on to a DMO. Initial applicant waivers
must also be approved by NDSTC prior to the member commencing training.
Appropriate documentation for the waiver request includes:
(1) A Chronological Record of Care, SF-600 prepared by the examining HCP
requesting the waiver referencing the specific standard for which the
member is not physically qualified, a clinical synopsis including history,
focused examination, clinical course, appropriate ancillary studies, and
appropriate specialty consultation, followed by a recommendation of
“waiver recommended” or “waiver not recommended” with supporting
rationale.
(2) Endorsement by the member’s CO.
(3) Enclosure documentation of pertinent studies supporting the waiver or
recommending disqualification.
(4) Specialty consult supporting the waiver or recommending
disqualification.
f. Fitness for diving duty. Any credentialed CG health care provider can
recommend to the command a limited duty status based upon medical illness
or injury. An ill or injured diver may only be returned to diving duty by a
qualified DMO.
2. Standards.
a. Age Requirements. Candidates beyond the age of 35 shall not be considered
for initial training in diving.
b. Ear, Nose and Throat. Chronic Eustachian tube dysfunction or inability to
equalize middle ear pressure is disqualifying. Any persistent vertigo,
dysequilibrium, or imbalance with inner ear origin is disqualifying.
Maxillofacial or crainiofacial abnormalities precluding the comfortable use of
diving headgear, mouthpiece, or regulator is disqualifying. Hearing must
meet standards for initial acceptance for active duty. Hearing standards are:
(1) 1000Hz -30dB, 2000Hz-35dB, 3000Hz- 45dB, 4000Hz-55dB
(2) Results greater than the above listed dB require a waiver.
Designated divers with full recovery from either tympanic membrane
perforation or acute sinusitis may be returned to diving duties after
evaluation by a DMO.
c. Eyes and Vision. All divers must have corrected visual acuity not worse than
20/25 in one eye. For Second Class Divers (DV2) assigned to diving duty and
Diving Medical Technicians (DMT): 20/20 in each eye. History of refractive
corneal surgery is not considered disqualifying. However, candidates must
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COMDTINST M6000.1E
wait 3 months following their most recent surgery (PRK or LASIK), have
satisfactory improvement in visual acuity, and be fully recovered from any
surgical procedure. A designated diver must wait 1 month post-LASIK/PRK
and be fully recovered from any surgical procedure with satisfactory
improvement in their visual acuity prior to resumption of diving. Corneal
complications lasting 6 months or longer after cessation of hard contact lens
wear is disqualifying. Lack of adequate color vision is disqualifying.
Waivers will be considered on a case-by-case basis.
d. Pulmonary. History of spontaneous pneumothorax is disqualifying. Traumatic
Pneumothorax (other than caused by a diving-related pulmonary barotrauma)
is disqualifying. A waiver request will be considered for a candidate or
designated diver after a period of at least 6 months and must include: a normal
pulmonary function test, standard, non-contrast chest CT, favorable
recommendation from a pulmonologist, and final evaluation and approval by a
DMO. Chronic obstructive or restrictive pulmonary disease is disqualifying.
Candidates and designated divers undergoing drug therapy for a positive
Tuberculin Skin Test (TST) must complete a full course of chemoprophylaxis
prior to the start of diver training or reinstatement to diving duty. Designated
divers who experience mediastinal or subcutaneous emphysema resulting
from a dive are restricted from diving duty for 1 month. They may be
returned to diving duty following completion of the waiver process if the diver
is asymptomatic and is determined to have a normal, standard, non-contrast
chest CT. A history of pulmonary barotrauma in a diver candidate is
disqualifying. Designated divers who experience a second pulmonary
barotrauma are considered permanently disqualified for diving duty.
e. Skin and Lymphatics. Skin cancer or severe chronic or recurrent skin
conditions exacerbated by sun exposure, diving, the hyperbaric environment
or the wearing of occlusive attire (e.g., a wetsuit) are disqualifying.
f. Gastrointestinal. Gastroesophageal reflux disease that interferes with or is
aggravated by diving duty is considered disqualifying. Designated divers with
full recovery from acute infections of abdominal organs may be returned to
diving duties at the discretion of a DMO. Designated divers with a history of
symptomatic or bleeding hemorrhoids may be returned to diving duties at the
discretion of a DMO. Designated divers with a full recovery from abdominal
surgery (including hernia repair) may apply for a waiver after 3 months of
post-operative recovery.
g. Genitourinary. Invasive cancer is disqualifying. Designated divers with a full
recovery from acute infections of genitourinary organs may be returned to
diving duties at the discretion of a DMO. Pregnancy is disqualifying. Postpartum members are eligible for diving duties 6 months after delivery. Return
to earlier duty requires a waiver.
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COMDTINST M6000.1E
h. Dental. All divers must be dental class 1 or 2. Fixed active orthodontic
appliances require a waiver from PSC-opm or epm (fixed retainers are
exempt).
i. Musculoskeletal. Any musculoskeletal condition that is chronic or recurrent
which predisposes to diving injury, limits performance of diving duties, or
may confuse the diagnosis of a diving injury is disqualifying. Any fracture
(including stress fractures) is disqualifying if it is less than 3 months post
injury, and if there are any residual symptoms. Designated divers with full
recovery from uncomplicated fractures with no residual pain may be
reinstated at the discretion of a DMO. Bone or joint surgery is disqualifying if
it is within 6 months and there is any significant or functional residual
symptoms. Retained hardware is not disqualifying unless it results in limited
range of motion.
j. Psychiatric. The special nature of diving duties requires a careful appraisal of
the candidate's emotional, temperamental, and intellectual fitness. Past or
recurrent symptoms of neuropsychiatric disorder or organic disease of the
nervous system are disqualifying. No individual with a history of personality
disorder shall be accepted. Neurotic trends, emotional immaturity or
instability and antisocial traits, if of sufficient degree to militate against
satisfactory adjustment are disqualifying. Stammering or other speech
impediment that might become manifest under excitement is disqualifying.
Treatment of any emotional, psychological, behavioral, or mental dysfunction
should be completed and the diver asymptomatic before return to duty is
supportable by a waiver. No time limit is required post treatment but the
recommendation of the attending mental health professional of fitness for full
duty and concurrent assessment of fitness for duty by a DMO is sufficient to
begin the waiver process. Use of psychotropic medication for any purpose
including those that are not psychiatric such as smoking, migraine headaches,
pain syndromes, is not prohibited with diving duty but must be approved by a
DMO. Diagnosis of alcohol dependence will result in disqualification until
successful completion of a treatment program and a 1-year aftercare program.
A diagnosis of alcohol abuse or alcohol incident will result in disqualification
from diving duty until all recommended treatment courses or course mandated
by the members CO have been completed.
k. Neurological. Idiopathic seizures are disqualifying except for febrile
convulsions before age 5. Two years of non-treated seizure-free time is
necessary before a waiver will be considered. Seizures with known cause
may be returned earlier to duty by waiver. Syncope, if recurrent, unexplained,
or not responding to treatment is disqualifying. All dive physicals require
documentation of a full neurologic examination and tympanic membrane
mobility in blocks 44 and 72b respectively on the Report of Medical
Examination, DD 2808.
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COMDTINST M6000.1E
l. Decompression Sickness / Arterial Gas Embolism. In a diving duty candidate,
any prior history of decompression sickness or arterial gas embolism is
disqualifying and requires a waiver. Designated divers diagnosed with any
decompression sickness (including symptoms of joint pain or skin changes)
shall: have an entry made in their medical record describing the events and
treatment of the injury, signed by the attending DMO and be evaluated by a
cardiologist for presence of a patent foramen ovale (PFO) with results
documented in health record. Designated divers diagnosed with AGE or DCS
type II presenting with neurological, pulmonary, or shock symptoms will be
disqualified for diving duty pending work-up and evaluation by a DMO and
waiver approval.
m. Required Labs and Special Studies. For candidates applying for initial dive
duty and for designated diver physical examinations the following labs and
special studies are required in support of Report of Medical Examination, DD2808: Serology, CBC with Diff, Lipid panel, Fasting blood glucose, HIV,
Urinalysis, Hepatitis C screening, G6PD, Sickle Cell, Blood type, Chest x-ray
(PA and lateral), Audiogram, EKG, and PPD. In addition to the Immunization
and Chemoprophylaxis (Joint Publication), COMDTINST M6230.4 (series)
requirements, all diver candidates and designated divers must be immunized
against both Hepatitis A and B. Diver candidates must have two doses of
Hepatitis A immunization and at least the first two of three doses of Hepatitis
B immunization prior to the start of diver training.
n. Miscellaneous. The use of Bupropion for tobacco cessation is not
disqualifying for diving duty, but requires approval by a DMO. Qualified
divers or dive candidates are not fit for diving duty when they are taking INH
for positive TST testing. Waiver must be obtained to return to diving duty.
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